PubMed HealthSearch

Biomedical subjects

P M Miller

Publications and source records attributed to P M Miller.

At least 19 recordsLinked to original sources

Social support and its interactions with personality and childhood background as predictors of psychiatric symptoms in Scottish and American medical students.

Two samples of first year medical students were studied, one in Houston, Texas, the other in Edinburgh, Scotland. Personality, measured on entry, and social support, measured prior to first year examinations, were used to predict scores at the latter time on anxiety self-ratings, depression self-ratings and the General Health Questionnaire. At both centres social support was implicated in symptomatology, but many significant effects were centre specific. Presence of a local friend in whom to confide, was important in Houston, while support from a relative and superficial support from classmates were salient in Edinburgh. In general, presence of support was associated with lower symptoms, but there were important exceptions similar in both centres. Students who did not have a boy/girl friend during the study period were less anxious than the rest. Regarding personality, students high on suspiciousness were more anxious and depressed when they had high levels of support. Among reserved (aloof and introspective) students both gain and loss of a boy/girl friend during the year were strongly associated with depressed mood. It is concluded that, particularly for students high in suspiciousness, reserve and shyness, the costs of social relationships sometimes outweigh the benefits.

Adult

Treatment of essential tremor with methazolamide.

We treated 28 patients (16 women and 12 men) who had essential tremor with methazolamide. Their median age was 69 years (range, 34 to 89 years), and the median duration of tremor was 16 years (range, less than 1 to 69 years). Fifteen cases were familial and 13 were sporadic. Improvement in 10 patients who continued taking the drug ranged from moderate to complete relief. In addition, four patients had marked improvement and two had moderate improvement but discontinued use of the drug because of side effects. Five patients with a mild response and seven with no response also discontinued methazolamide therapy. The maximal mean daily dose was 203 mg for all patients and 129 mg (maintenance dose) for the patients who continued taking the drug. Side effects consisted primarily of somnolence, nausea, epigastric discomfort, anorexia, paresthesias, and numbness. No aplastic anemia was noted in any of the patients. The median duration of follow-up was 6 months (range, 10 weeks to 29 months). The therapeutic effect seemed unrelated to a family history of tremor, the effect of alcohol, or the responsiveness to propranolol or primidone. Methazolamide may be an effective drug in the treatment of some patients with essential tremor, particularly those with head and voice tremor.

Adult

Parkinson's disease monotherapy with controlled-release MK-458 (PHNO): double-blind study and comparison to carbidopa/levodopa.

The potent and selective dopamine D-2 agonist, MK-458 [PHNO; (+)-4-propyl-9-hydroxynaphthoxazine] was administered as monotherapy to nine patients with Parkinson's disease in a double-blind, placebo-controlled 12-week investigation; ten other patients were randomized to placebo. MK-458 was formulated as a controlled-release preparation, using a hydroxypropyl methylcellulose-lactase (HPMC) matrix. Patients receiving MK-458/HPMC improved on a variety of measures of parkinsonism, compared to their baseline scores; in contrast, only trivial improvement was seen within the placebo group. We subsequently compared the anti-Parkinson response to MK-458/HPMC with the response to chronic carbidopa/levodopa monotherapy in an open label trial. Carbidopa/levodopa improved parkinsonism to a significantly greater degree than MK-458/HPMC. Doses of MK-458 used in these studies (up to 60 mg per day) were substantially higher than those in previously reported preliminary studies of this medication. We conclude that monotherapy with MK-458/HPMC results in a significant anti-Parkinson effect; however, the response falls short of that seen with carbidopa/levodopa.

Adult

Psychological symptoms and their course in first-year medical students as assessed by the Interval General Health Questionnaire (I-GHQ).

Evidence is presented concerning the concurrent validity of the Interval General Health Questionnaire. This was used to describe the timing and course of spells of depression and anxiety symptoms in first-year medical students over their initial six months at university. A small subgroup of students who were continuously symptomatic were distinguished from other groups by the presence of a number of factors: they were slow to make friends, had inappropriate support from relatives, had a tendency to have rows, had steady girl/boyfriends and had 'vulnerable' personalities. By contrast, a large subgroup who were well throughout had experienced caring childhood backgrounds, seldom had girl/boyfriends, showed little tendency to have rows and had 'resilient' personalities. Other subgroups are also described. It is suggested that students who suffer from chronic minor symptomatic distress could be recognised early on and offered appropriate support from counselling services.

Adult

The Interval General Health Questionnaire.

An adaptation of the LIFE procedure was used with a self-report questionnaire to assess 173 medical students, close to their enrollment and again about six months later. The assessment procedure enabled changes in symptoms of anxiety and depression over the interval between interviews to be recorded and the subsequent classification of the symptom patterns into course categories. While women scored markedly higher than men at initial assessment, this was not so at follow-up. Almost 25% of students reported the co-occurrence of at least five psychological symptoms at some time during the six months. For many students these were of a persistent nature. The adapted GHQ meets the dual demands of restricted interview time and the need to assess the more minor psychological conditions.

Adaptation, Psychological

Affective disorders among women in the general population and among those referred to psychiatrists. Clinical features and demographic correlates.

In a study comparing depressive disorders detected in a field survey (n = 90) with patients referred to a specialist treatment setting (n = 63), the clinical features and demographic correlates of 'cases' of affective disorders proved to be similar. However, those in treatment settings appeared to have more people achieving definite case status. Hospital-referred cases were also more likely than community cases to be older and single, and this difference persisted even after controlling for chronicity of symptoms.

Adolescent

Emergence of alcohol expectancies in childhood: a possible critical period.

Previous investigations with adolescents (aged 12-19) have shown alcohol-related expectancies to develop in childhood prior to significant drinking experience and to covary directly with drinking behavior. To chart the development of alcohol expectancies in children as young as age 6, a procedure was developed to be as independent as possible of age-related variation in reading and language development. This instrument was administered to 114 elementary school children of both genders, distributed across grades 1 to 5. Psychometric analysis provided evidence of the test's reliability and validity. Evaluation of the developmental pattern produced two primary findings: (1) there was an overall trend of increasingly positive expectancies with age; and (2) strikingly, the bulk of the increase was observed in the third and fourth grades. Children's expectancies may be less differentiated than adolescent or adult expectancies. These findings suggest that the precursors for later alcohol use and abuse are formed in childhood and that prevention efforts may need to begin as early as third grade.

Age Factors

Ethylenediaminetetra(methylenephosphonic acid): genotoxicity, biodistribution, and subchronic and chronic toxicity in rats.

Ethylenediaminetetra(methylenephosphonic acid), EDITEMPA, was tested for oral toxicity in rats in a 13-wk feeding study (at doses of 0, 5, 50 and 500 mg/kg/day) and in a chronic feeding study (at doses of 0, 4, 20 and 100 mg/kg/day). EDITEMPA was also tested for genotoxicity in the Ames, mouse lymphoma, unscheduled DNA synthesis, and in vivo cytogenetics assays. Additionally, absorption, distribution and excretion (ADE) studies were conducted following administration of [14C]EDITEMPA to rats by gavage and via the feed and drinking-water. The principal finding in the 13-wk study was mild anaemia in male and female rats given 500 mg/kg/day, which was resolved during a 9-wk recovery period. In the chronic study, there was no substantial evidence of any treatment-related toxicity or carcinogenicity. Differences in survival of control and treated females (noted late in the study) were interpreted to represent unusually good survival in controls; however, a compound-related increase in mortality could not be completely ruled out. Tests for genotoxicity were all negative. ADE studies revealed that [14C]EDITEMPA was poorly absorbed from the gastro-intestinal tract and that most of the absorbed dose was rapidly excreted by the kidneys or sequestered in bone. The gavage route of administration led to four- to six-fold increases in bone EDITEMPA levels as compared with administration in the feed and drinking-water, respectively. These results suggest that no significant toxicity or carcinogenicity concerns arise from EDITEMPA when it is administered in the feed at the concentrations tested. Reversible anaemia was seen only at very high doses and was interpreted as being secondary to EDITEMPA's ability to interfere with iron absorption and utilization. Localization of EDITEMPA in bone indicated a high degree of affinity for mineralizing tissues, consistent with its chelating properties. There was, however, no effect on bone resorption or mineralization. A comparison of human drinking-water levels of 3500 ppm EDITEMPA (based on a no-effect level of 100 mg/kg/day in rats) with the estimated worst-case exposure in humans of 0.01 ppm suggested a safety margin greater than 1 x 10(5).

Administration, Oral

Hospital-treated and general-population morbidity from affective disorders. Comparison of prevalence and inception rates.

In this study, we compare the rates of psychiatric disorders found among women in a random sample of the general population with those of patients referred to specialist services. Both these groups were drawn from the same geographical area. The ratio of prevalence rates is less than the ratio between inception rates in the two groups. When only those with affective disorders were considered, the results revealed that the point prevalence in the treated-disorders group was only 1% of the community-group prevalence, while the inception into care in the former group was nearly 6% of that in the latter. Single women and older women were over-represented in the hospital sample.

Adolescent

Life events, psychiatric illness and the irritable bowel syndrome.

The frequency, severity, and characteristics of psychiatric illness and stressful life situations were assessed in 134 patients aged 18-60 years referred to a gastrointestinal clinic by their general practitioner. A functional disorder of the gastrointestinal tract was established in 72%. A formal psychiatric assessment in 64 randomly selected patients revealed a previous or current psychiatric disorder in 54% of the functional group and 12.5% of the organic group. Stressful life events before referral were assessed by a modification of the Bedford College methodology. Anxiety provoking life situations were found in 30%, a proportion which was not significantly different in the two groups. Psychiatric illness episodes and/or anxiety provoking situations, preceded the onset of bowel symptoms in two-thirds of the functional group, however, but in none of the organic group. Life situations alone did not appear to be associated with functional disorders unless they provoked an anxiety state.

Adolescent

Self-appraisal, anxiety and depression in women. A prospective enquiry.

Depressive illness is known to be associated with low self-evaluation, but it has been suggested that there may be a reciprocal connection as well, such that low self-appraisal (in the absence of illness) makes the subsequent onset of depression more likely. A prospective study, using a community sample of 376 women, provided data about clinical state over a period of 18 months, and self-appraisal questionnaire scores were determined on two occasions separated by 6 months. There was no evidence that low self-evaluation predicted future episodes of depressive illness, except in women who reported previous psychological episodes for which they had sought medical help, and, even for those with previous episodes, much of the predictive power of low self-esteem was accounted for by individuals who were subsequently recognised to have been in the early stages of illness. Conversely, there was little evidence that prior episodes predicted future illness in people with high self-esteem. One explanation of the findings is that recurrent episodes of illness cause progressive impairment of self-appraisal, but other possibilities are also considered. Women who had recovered from illnesses detected at the first interview still had significantly less self-confidence 6 months later than those who were well throughout.

Anxiety Disorders

Self-referral to primary care: symptoms and social factors.

Previous analyses of data obtained from a comparative study of Health Centre consulters and controls have indicated that the influence of social and demographic factors upon consulting behaviour is slight compared with that of symptom severity. However, the samples were very heterogeneous and some variables may be influential for certain sub-groups but not for others. Subjects were classified according to whether they thought their symptoms were caused by internal physical, external physical or psychological factors. For all groups the likelihood of consultation was highest for those who said they had no idea what caused their ill-health and for those who thought it had an internal physical cause. A significant interaction between marital status and attributed cause showed that the reduced likelihood of consultation amongst women living in a stable relationship with husband or cohabitee, did not apply to those who attributed their symptoms to an external physical cause. Changes in patients' concepts of causation following the consultation with their doctor supported the idea that the GP often succeeds in reassuring patients who cannot understand their symptoms or who, without reason, fear they may be suffering from serious physical illness.

Adolescent

Epidemiology of industrial burns in Brisbane.

A retrospective epidemiological study of industrial burns admitted to the Royal Brisbane Hospital was conducted over a period of 7 years. A total of 182 patients were included in this survey--173 males (95 per cent) and 9 females (5 per cent). The proportion of industrial burns has decreased from 31.5 per cent to 18.5 per cent of total admissions to the burns unit over the past 10 years. Fifty per cent of the burns occurred in males less than 30 years old. The average age was 31 years. Two-thirds of the burns covered less than 10 per cent of the body and 84 per cent covered less than 20 per cent. While scalds were the commonest cause of industrial burns in our study (19.4 per cent), flame burns with clothing ignited caused the most extensive burns. Face and hands were the most common sites involved. Burns to these regions were mainly caused by flame and electrical burns. Eye burns comprised 5.5 per cent of the sample and were due to chemicals, gas explosions and electric flash. Twenty-six patients (14 per cent) suffered respiratory injury. Only one patient out of our series of 182 died. Progress has been made in industrial safety in the past few years but carelessness and human error still take their toll.

Accidents, Occupational

Self-esteem, vulnerability and psychiatric disorder in the community.

One hypothesis concerning the nature of the link between negative self-appraisal and certain psychological disorders is that low self-esteem may be a consequence of both early and current experiences, and may predispose to breakdown. An alternative view is that the negative self-concept is only to be found in the presence of illness, which is the primary cause. Results are reported from a community survey, confirming the influence of certain biographical factors on self-esteem in the absence of illness, whereas other factors appear to operate only after the onset of illness. Anxiety as well as depression, has effects on self-esteem.

Adolescent

The epidemiology of life events and long-term difficulties, with some reflections on the concept of independence.

A total of 576 women aged 18-65, drawn from an area in Edinburgh, were interviewed. Data on life events and long-term difficulties over a six-month period prior to interview were gathered and classified according to area of life, the Bedford system, the Edinburgh system, and the independence of the event or difficulty from the subject's own actions. The highest rates of Bedford system 'provoking' situations were found in the working class, among those not employed, among women with three or more children under 14, and in the separated, divorced, widowed or cohabitating group. Similar findings emerged for hopeless situations involving choice or loss. Dependent situations were four times more common in the youngest group than the oldest, and showed a high rate among those divorced, separated, widowed, or cohabiting. It is suggested that both dependent and independent life situations should be studied.

Adolescent

Neurosis divisible?

Explore the source record for details and available documents.

Anxiety Disorders