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Biomedical subjects

R G Priest

Publications and source records attributed to R G Priest.

At least 19 recordsLinked to original sources
PubMed1992

Recent advances in antidepressant drugs.

Tricyclic antidepressants (TCAs) are notorious for a number of disadvantages, but particularly for an array of side-effects that leads to poor compliance, and also for a dangerous toxicity in overdose. Lofepramine is a new tricyclic that seems safer. Selective serotonin reuptake inhibitors (SSRIs) are more limited in their actions. Side-effects include nausea and insomnia, but on the whole the side-effect profile is an improvement on the TCAs. A miscellaneous group of novel antidepressants includes mianserin and trazodone (which both produce drowsiness) and viloxazine (which causes nausea). The reversible inhibitors of monoamine oxidase A (RIMAs) are a group of drugs that, by producing inhibition selectively of monoamine oxidase A (MOA-A), still allow metabolism of tyramine by MAO-B. Moclobemide is a RIMA that has proved itself to be very effective in severe depressive illness. It is remarkably safe and has an exceptionally low incidence of side-effects. It may be expected to be associated with a high acceptability in depressed patients.

Antidepressive Agents↗
PubMed1992

The treatment of sleep disorders.

Narcolepsy is clinically associated with cataplexy, sleep paralysis and hypnagogic hallucinations. It is treated by reassurance (that there is no physical disease) and by stimulants such as ephedrine and amphetamine on an intermittent basis. The special tricyclic antidepressant clomipramine is also used, and mono-amine oxidase inhibitors (MAOIs) are useful in theory. Obstructive sleep apnoea is an important and often unrecognised cause of daytime somnolence. It is treated by weight reduction (pickwickian syndrome), hormones, or recently, with continuous positive pressure apparatus. Night terrors (pavor nocturnus) and sleepwalking typically occur during deep sleep (stage 3 and 4 throughout the episode) in children. In a night terror the child sits up with a scream, with eyes open, but inaccessible. He eventually falls asleep calmly. Sleepwalking, too, shows the features of inaccessibility and subsequent amnesia for the episode. Both conditions are normally treated with reassurance (to the parents) but may occasionally warrant benzodiazepines. Enuresis usually occurs in non-rapid eye movement (NREM) sleep, especially stages 3 and 4. The reason for the efficacy of tricyclic antidepressants is not precisely known. Delirium tremens (DT) is treated as a rebound excess of REM sleep, with benzodiazepines and other drugs. It is the withdrawal syndrome (with or without major seizures) to the barbiturate-alcohol group of drugs, which includes alcohol, chloral, paraldehyde, glutethimide, methylprylone, ethchlorvynol, meprobamate and meprobamate-diphenhydramine. Insomnia may be treated by the above drugs, by analgesics, antidepressants, major tranquillisers (neuroleptics) and miscellaneous other compounds. For the majority of patients, however, the most suitable group seems to be the benzodiazepines. The benzodiazepines are much safer than their predecessors, in both acute and chronic usage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Minaprine and dose response in depression. An investigation of two fixed doses of minaprine compared with imipramine.

One hundred and twelve patients suffering from moderate to severe major depression (DSM III) were enrolled into a study to compare the antidepressant activity and side effect profiles of two dosage groups of minaprine (200 mg and 300 mg per day) and one of imipramine (150 mg per day) in psychiatric practice. Eight patients were withdrawn because of unwanted effects (four imipramine, one minaprine 200 mg, three minaprine 300 mg) and seventy-eight spontaneous reports of unwanted effects were made from the imipramine group compared with sixty-four from the minaprine 200 mg and forty-six from the minaprine 300 mg groups. The main efficacy analysis was carried out at 4 weeks on the 89 evaluable patients who completed 2 weeks active treatment, the last observation being carried forward in those patients who did not complete. A secondary analysis was also carried out at 6 weeks. The response in all three treatment groups showed a significant improvement from the severity at entry to the study, and the response rate to minaprine 200 mg daily was similar to that of imipramine (53% vs 54% achieving a reduction of 50% or more on the Hamilton Depression Rating Scale by week 6), although, given the small group sizes, similar efficacy cannot be claimed. In the intention to treat analysis there was a significant dose response relationship with significantly more patients in the lower minaprine 200 mg dose group achieving 50% or more reduction in the Hamilton Rating Scale than the minaprine 300 mg group at week 4 (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

A comparison of the hypnotic effects of temazepam capsules and temazepam elixir.

The effect of temazepam as a hypnotic was assessed with two different formulations, the solution-filled soft gelatin capsule and the more recently introduced elixir. Sixty psychiatric in-patients were included in the trial and 59 completed it. The study followed a double-blind crossover design for two consecutive nights. Patients took a capsule and elixir each night, but only one would contain the active ingredient (in a dose of 20 mg temazepam). In contrast to earlier work with volunteers, the elixir failed to reveal more of the characteristics of an ideal hypnotic. In fact, in those measures that were statistically significant, the balance favoured the capsule. We conclude that although there are many situations where an elixir is clearly clinically preferable, the essential hypnotic effect of the elixir is not conspicuously different to that of the capsule.

Adolescent↗
PubMed1991

Suicidal ideation as a presenting complaint. Associated diagnoses and characteristics in a casualty population.

A prospective study was conducted of all referrals to the emergency psychiatric service of an inner-London hospital over one year. There were 53 individuals who presented with the specific and spontaneous complaint of suicidal ideation without any accompanying act of self-harm. The main diagnoses in this group were personality disorders (40%) and alcohol dependence (15%); only 13% were suffering from depressive illness. Members of the group differed from the other 369 presenters to the service in that they were less likely to be accorded a diagnosis of a defined mental illness, twice as likely to have a criminal record, and more likely to have a previous history of deliberate self-harm. A quarter of the suicidal complainants were admitted to hospital following assessment.

Adolescent↗
PubMed1990

An increase in violence on an acute psychiatric ward. A study of associated factors.

The increase in violent incidents on an acute psychiatric ward over a 15-month period was found to be strongly associated with the increase in use of temporary nursing staff (r = 0.63; P = 0.0005). The change in staffing patterns accounted for 39% of the variance in violence. An examination of the characteristics of all patients admitted to the ward revealed that the violent patients were significantly younger, more likely to have been admitted compulsorily and less likely to be depressed than non-violent ones.

Acute Disease↗
PubMed1988

Relaxation and imagery in the treatment of breast cancer.

OBJECTIVE: To see whether stress could be alleviated in patients being treated for early breast cancer. DESIGN: Controlled randomised trial lasting six weeks. SETTING: Outpatient radiotherapy department in a teaching hospital. PATIENTS: One hundred fifty four women with breast cancer stage I or II after first session of six week course of radiotherapy, of whom 15 dropped out before end of study. INTERVENTION: Patients saw one of two researchers once a week for six weeks. Controls were encouraged to talk about themselves; relaxation group was taught concentration on individual muscle groups; relaxation and imagery group was also taught to imagine peaceful scene of own choice to enhance relaxation. Relaxation and relaxation plus imagery groups were given tape recording repeating instructions and told to practise at least 15 minutes a day. END POINT: Improvement of mood and of depression and anxiety on self rating scales. MEASUREMENTS AND MAIN RESULTS: Initial scores for profile of mood states and Leeds general scales for depression and anxiety were the same in all groups. At six weeks total mood disturbance score was significantly less in the intervention groups, women in the combined intervention group being more relaxed than those receiving relaxation training only; mood in the control group was worse. Women aged 55 and over benefited most. There was no difference in Leeds scores among the groups. CONCLUSIONS: Patients with early breast cancer benefit from relaxation training.

Affect↗
PubMed1986

A comparative trial of depot pipothiazine.

Thirty-nine chronic schizophrenic patients were selected for a 12-month double-blind evaluation of the effectiveness of pipothiazine palmitate (PPT) and flupenthixol decanoate (FPX) in the maintenance management of their illness. Allocation was at random and, in order to allow constant injection intervals, the patients typically received every 2 weeks either 40 mg of flupenthixol decanoate or alternating injections of 100 mg of pipothiazine palmitate and placebo. At monthly intervals the patients were assessed using both a battery of rating scales (which included the Brief Psychiatric Rating Scale (BPRS), the Extrapyramidal Symptoms Rating Scale (EPS] and a general side-effects evaluation. At 3-monthly intervals they were also rated on the Comprehensive Psychiatric Rating Scale (CPRS) and the Zung Depression Scale. Haematological and biochemical tests were performed every 3 months. Both drugs provided good control of psychotic symptoms and side-effects were not troublesome. No substantial difference was detected on the CPRS and the Zung scales. There was a trend in favour of PPT on the BPRS survey, detectable at 6 months and reaching statistical significance by 12 months. We conclude that the PPT regime is at least as effective as the FPX treatment and probably more so. It is possible that even longer periods of control could be obtained with PPT.

Adult↗
PubMed1979

Teaching the future general practitioner.

Medical students today still graduate with insufficient skills for their role as general practitioner (family doctor, primary care physician). In particular they are lacking in their ability to use psychotherapeutic and counselling techniques for patients with psychological and psychosomatic problems. The author presents the results of a study which suggest that it is unrealistic to teach skills that demand more than, say, 15 min a session on a total of four occasions. This severe limitation poses difficult questions for those teachers who customarily think in terms of 50 min a week over many months as the basis of the model for psychotherapeutic help. The challenge of these implications is considered, and some practical ways of meeting the requirements are suggested.

Clinical Competence↗