Biomedical subjects
Publications and source records attributed to P Moodley.
Mesenchymal hamartoma of the liver is a rare benign tumour of childhood, characterised by an admixture of ductal structures within a copious loose connective tissue stroma. Less consistent features include hepatocytes and haemopoietic elements. The stroma has a propensity to accumulate fluid and to create macroscopic cystic spaces. Five cases are reported.
In view of the very extensive and often prolonged use of benzodiazepines in therapeutic practice, this study was designed to investigate whether or not cognitive ability is impaired in long-term benzodiazepine users, and to determine the nature and extent of any deficit. Fifty patients currently taking benzodiazepines for at least one year, thirty-four who had stopped taking benzodiazepines, and a matched control group of subjects who had never taken benzodiazepines or who had taken benzodiazepines in the past for less than one year were administered a battery of neuropsychological tests designed to measure a wide range of cognitive functions. It was found that patients taking high doses of benzodiazepines for long periods of time perform poorly on tasks involving visual-spatial ability and sustained attention. This is consistent with deficits in posterior cortical cognitive function.
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Withdrawal from long-term treatment with benzodiazepines was followed in three patients by a severe delusional depression. The delusional depression may be related to the neurotransmitter changes accompanying benzodiazepine withdrawal. Caution should be exercised in long-term use of benzodiazepines in susceptible individuals.
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Dependence is a recognized problem in a significant number of patients taking therapeutic doses of benzodiazepines. A characteristic withdrawal syndrome has been described. These patients are best managed as outpatients with gradual dosage reduction over 4-12 weeks. Pharmacological adjuncts such as propranolol and non-benzodiazepine hypnotics are useful for certain specific symptoms, but so far no single substance has proved useful in attenuating the majority of symptoms. Psychological and social support should be maximized, but here again no single technique has been shown to be more than moderately successful. The best treatment is thoughtful prescribing ab initio.
24 normal, healthy subjects were assigned randomly to 15 mg clorazepate dipotassium or placebo groups in a double-blind study. Their performance on a psychological test battery was assessed 45 min. later. Clorazepate dipotassium produced statistically significant impairment in attention and simple reaction time compared with placebo. Performance on more complex tests of cognitive functioning showed no drug effects.
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