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Biomedical subjects

R G Robinson

Publications and source records attributed to R G Robinson.

At least 127 records · Page 7Linked to original sources
PubMed1992

Anosognosia in patients with cerebrovascular lesions. A study of causative factors.

BACKGROUND AND PURPOSE: Psychological and biological hypotheses have been proposed to explain anosognosia. We correlated the presence of anosognosia with the presence and severity of psychiatric disturbances, neglect, intellectual impairments, and computed tomographic evidence of lesion size, location, and measurements of brain atrophy. METHODS: A series of 80 patients with acute stroke were assessed using a battery of psychiatric and neuropsychological tests and computed tomography. RESULTS: There were five main findings. First, 27 (28%) of the 96 patients originally screened showed anosognosia. Second, patients with anosognosia had significantly higher frequencies of hemispatial neglect and related phenomena, as well as deficits in recognizing facial emotions and in receptive prosody. Third, depression was equally frequent among patients with and without anosognosia. Fourth, patients with anosognosia had a significantly higher frequency of right hemisphere lesions, primarily involving the temporoparietal junction, thalamus, and basal ganglia. Fifth, patients with anosognosia showed significantly more subcortical brain atrophy, primarily involving the frontal white matter and diencephalic areas. CONCLUSIONS: The present study demonstrates that anosognosia does not "protect" stroke patients from depressive feelings; rather, it represents arousal-attentional disorders after lesions in specific areas of the right hemisphere in nonaphasic patients with preexisting subcortical atrophy.

Aged↗
PubMed1992

Depression in patients with acute traumatic brain injury.

OBJECTIVE: This study was undertaken to examine patients with closed head injuries for the presence of depressive disorders. METHOD: A consecutive series of 66 patients with closed head injuries but no significant spinal cord or other organ system injury were examined by means of a semistructured psychiatric interview. The Hamilton Rating Scale for Depression as well as scales measuring impairment in activities of daily living, intellectual functioning, and social functioning were administered. The patients' CT scans were also examined. RESULTS: Seventeen patients had major depression and two had minor depression. The presence of left dorsolateral frontal lesions and/or left basal ganglia lesions and, to a lesser extent, parietal-occipital and right hemisphere lesions was associated with an increased probability of developing major depression. Compared to the nondepressed group, the group with major depression had a higher frequency of previous psychiatric disorder and showed evidence of poorer social functioning. CONCLUSIONS: Major depression occurs in about one-quarter of patients after traumatic brain injury. This is the same frequency as in other major disorders such as stroke. Major depression appears to be provoked by one or more factors that include poor premorbid social functioning and previous psychiatric disorder or injury to certain critical brain locations.

Activities of Daily Living↗
PubMed1992

Reliability, validity, and clinical correlates of apathy in Parkinson's disease.

The authors examined a consecutive series of 50 patients for the presence of apathy, depression, anxiety, and neuropsychological deficits using a neuropsychological battery that included a recently designed apathy scale. This scale was found to be reliable and valid in the diagnosis of apathy in patients with PD. Of patients in the study, 12% showed apathy as their primary psychiatric problem, and 30% were both apathetic and depressed. Patients with apathy (with or without depression), showed significantly more deficits in both tasks of verbal memory and time-dependent tasks. Results suggest that apathy is a frequent finding in PD, is significantly associated with specific cognitive impairments, and may have a different mechanism than depression.

Aged↗
PubMed1992

Reduction of CSF monoamine metabolites in poststroke depression: a preliminary report.

Monoamine metabolites were measured in the cerebrospinal fluid (CSF) of depressed and nondepressed patients with acute stroke lesions and in nondepressed patients without stroke lesions. Depressed stroke patients had a significantly lower concentration of CSF 5-hydroxyindoleacetic acid (5-HIAA; a serotonin metabolite) than the other two groups. These findings suggest that poststroke depression may be mediated by serotonergic mechanisms.

Adult↗
PubMed1992

Sonographic diagnosis of infantile hypertrophic pyloric stenosis.

Twenty-five consecutive sonographic examinations performed at Flinders Medical Centre for possible infantile hypertrophic pyloric stenosis (IHPS) were analyzed retrospectively. The results and a pyloric muscle index calculated by a formula using length, diameter, muscle thickness, and body weight were compared with the clinical outcome (surgery or conservative management). In the children without IHPS, the calculated pyloric muscle index was less than 0.2, whereas in infants with proven pyloric stenosis, the index was greater than 0.2 (P < 0.001). This result suggested that the published index upper limit of > 0.4 to 0.46 was not valid in our institution. Pyloric length to muscle thickness ratio was also found to predict IHPS. A simplified index, including only length and muscle thickness, is proposed, whereby length (mm) plus 3.64 times thickness (mm), when greater than 25, implies IHPS.

Humans↗
PubMed1992

The relationship between risk factors for affective disorder and poststroke depression in hospitalised stroke patients.

The influence of psychiatric risk factors on the development of depression following stroke was examined in 88 patients undergoing inpatient rehabilitation. In this sample, 34 patients (38%) had a diagnosis of major or minor depression. Older age and a personal or family history of affective or anxiety disorder were associated significantly with major depression. Minor depression was more common among males and those patients with greater physical disability. Severity of depressive symptoms was associated with a personal or family history of affective or anxiety disorder and higher pre-stroke personality neuroticism. We conclude that certain psychiatric risk factors for affective disorder are strongly associated with poststroke depression. The implications of these findings for anticipating and managing poststroke depression are discussed.

Adaptation, Psychological↗
PubMed1991

Manic-depressive and pure manic states after brain lesions.

Although mania is a rare complication of brain lesions, recent reports have emphasized the importance of lesion location and genetic predisposition in these patients. In the present study we compared patients who developed a bipolar affective disorder (i.e., mania and depression) after a brain lesion with patients who only developed mania. Although no significant between-group differences were found on demographic variables, the manic-depressed group showed significantly more impairments on the Mini Mental State Exam than the mania only group. All the bipolar patients had subcortical lesions (mainly right head of the caudate and right thalamus), while patients with unipolar mania had significantly higher frequency of cortical involvement (mainly right orbitofrontal and basotemporal cortices). It is suggested that subcortical and cortical right hemisphere lesions may produce different neurochemical and/or remote metabolic brain changes that may underlie the production of either a bipolar disease or a unipolar mania.

Bipolar Disorder↗
PubMed1991

The relationship between the perception of social support and post-stroke depression in hospitalized patients.

In our study we examined the relationship between the perceived adequacy of social support and post-stroke depression in 76 hospitalized Australian patients. Social support or the perception of its lack, particularly from a spouse care-giver, was associated significantly with both the presence and severity of depressive disorder. Furthermore, depressed patients who perceived their support to be inadequate had a longer duration of depressive illness than depressed patients who perceived their support in a more favorable light. We conclude that following stroke, perception of social support from key relationships may mediate the emotional response to this life crisis. The implications of these findings are discussed.

Adaptation, Psychological↗
PubMed1991

Transcortical aphasia. Importance of the nonspeech dominant hemisphere in language repetition.

While a relative preservation of repetition in acute transcortical aphasia (TA) has usually been associated with the functional integrity of the speech dominant (left) perisylvian area, recent amytal data (Bando et al., 1986) have suggested a fundamental role of the nondominant (right) hemisphere in language repetition. The neuroradiological correlates of repetition were studied in a consecutive series of 21 patients with acute TA. A similar frequency of either perisylvian or extraperisylvian pathology was found. In 2 patients with perisylvian pathology, the injection of amytal in the hemisphere contralateral to the lesion abolished repetition. Positron emission tomography (PET) in another patient revealed marked hypometabolism over the entire left cortical mantle ipsilateral to a basal ganglia lesion, suggesting that preserved repetition was carried out by right hemisphere structures. This was confirmed in a second patient with left extraperisylvian pathology, in whom a second lesion in the right hemisphere resulted in impaired repetition. These findings suggest that the spared contralateral hemisphere may subserve residual repetition in some transcortical aphasic patients with a lesion within or outside the speech-dominant perisylvian area.

Aged↗
PubMed1991

Dementia of depression in Parkinson's disease and stroke.

Depression is a frequent finding in patients with neurological disorders. These depressions, however, have similar phenomenology, duration, biological markers, and response to treatment as depressions in patients with no known brain injuries (i.e., functional depression). In the present article, we review evidence that suggests the dementia of depression exists among severely depressed patients with cerebrovascular lesions or Parkinson's disease (PD). We conclude that: a) in patients with either stroke lesions or PD, depression is significantly associated with cognitive deficits; b) this association is only true for patients with major depression (i.e., it is not present in patients with minor depression); and c) patients with poststroke depression and patients with PD and depression have a severity and profile of cognitive deficits similar to those found in patients with primary major depression.

Cerebrovascular Disorders↗
PubMed1991

Sleep disorders, pain, and depression in Parkinson's disease.

A consecutive series of patients with Parkinson's disease (PD) were examined for the presence of sleep disturbances, pain, and depression. We found that patients with PD and major depression had significantly more sleep disturbances and severe pain than non-depressed patients with PD. Moreover, depression scores accounted for most of the variance in a stepwise regression analysis of the effect of numerous clinical variables on either sleep disorders or pain severity. These findings suggest that depression is the most important factor associated with the common problems of sleep disorder and pain among patients with PD.

Aged↗
PubMed1991

Are depressive symptoms nonspecific in patients with acute stroke?

OBJECTIVE: Some investigators have suggested that major depression might be overdiagnosed in stroke patients because of changes in appetite, sleep, or sexual interest caused by their medical illness; others have suggested that depression may be underdiagnosed in stroke patients who deny symptoms of depression because of anosognosia, neglect, or aprosody. The authors' goal was to determine how frequently depressive symptoms occur in acute stroke patients with and without depressed mood to estimate how often diagnostic errors of inclusion or exclusion may be made. METHOD: They examined the rate of autonomic and psychological symptoms of depression in 205 patients who were consecutively hospitalized for acute stroke. Eighty-five (41%) of these patients had depressed mood, and 120 (59%) had no mood disturbance. Forty-six (54%) of the 85 patients with depressed mood (22% of all patients) were assigned the DSM-III diagnosis of major depression. RESULTS: The 120 patients without mood disturbance had a mean of one autonomic symptom, but the 85 patients with depressed mood had a mean of almost four. Tightening the diagnostic criteria to account for one more nonspecific autonomic symptom decreased the number of patients with major depression by only three; adding two more criteria decreased the number by only five. Thus, the rate of DSM-III major depression was 1% higher than the rate with one extra nonspecific autonomic symptom and 2% higher than the rate with two extra criteria. Conversely, loosening diagnostic criteria to account for denial of depressive illness increased the rate of major depression by only 5%. CONCLUSIONS: Both autonomic and psychological depressive symptoms are strongly associated with depressed mood in acute stroke patients.

Acute Disease↗
PubMed1991

Risk factors for developing atypical (schizophreniform) psychosis following stroke.

Five patients who developed an atypical schizophreniform psychosis following right hemisphere stroke are described and compared to five patients matched for lesion size and location who did not develop any psychopathology after stroke. The patients who developed the schizophreniform illness had a larger frontal horn ratio and larger third ventricle ratio on CT head scans than did the comparison group. This finding suggests that preexisting subcortical atrophy and a right hemisphere lesion location are risk factors for developing schizophreniform disorder following stroke.

Aged↗
PubMed1991

Spontaneous remission of post-stroke depression and temporal changes in cortical S2-serotonin receptors.

A patient with post-stroke depression following infarction of the left basal ganglia is described. The patient's depression remitted during a 6-week double-blind treatment trial while receiving placebo medication. Cortical S2-receptor binding that was measured using 11C-N methyl spiperone and positron emission tomography (PET), increased in the left temporal cortex by more than 25% during the treatment trial. The change in serotonin receptor binding and its relationship to the improvement in mood observed in this patient are consistent with previously published data demonstrating a correlation between serotonin receptor binding in the left temporal cortex and severity of symptoms of depression.

Cerebral Cortex↗
PubMed1991

Depression after stroke: the importance of cerebral hemisphere asymmetries.

The pattern of brain asymmetries was visualized on computed tomography (CT) scan in patients with a single acute cerebrovascular lesion. Patients were divided into those with typical or reversed frontal and/or occipital asymmetries. Among patients with a typical occipital asymmetry, those with left frontal or left basal ganglia lesions showed a significantly higher frequency of major depression and significantly higher depression scores than patients with similar lesion location but with reversed occipital asymmetry or those with a typical asymmetry and lesions in other (left or right) brain areas. Among patients with a reversed occipital asymmetry, there was no significant association between left frontal or left basal ganglia lesions and depression. This study demonstrates that the previously reported significant association between post-stroke major depression and lesion location is restricted to patients with a typical occipital asymmetry and is not present in patients with a reversed occipital asymmetry.

Aphasia, Broca↗
PubMed1991

Cancer awareness among African Americans: a survey assessing race, social status, and occupation.

Knowledge of cancer prevention and control was defined in terms of prevention, etiology, treatment, symptoms, cancer rates, screening, and detection examinations. A survey of 86 African Americans and 68 white Americans in Alameda County, California was completed in 1985. An index comprised of 69 knowledge items was assessed. A multivariate analysis of race, education, socioeconomic status, and occupation confirmed that these characteristics were independent predictors of knowledge. Blue collar work status was the most important predictor of low knowledge levels. African Americans were less knowledgeable than white Americans with regard to diet in preventing cancer and treatment modalities for cancer, and were most likely to perceive surgery as contributing to metastases. Low education and income status predicted low levels of knowledge. An important consideration in changing knowledge levels is the need to translate technical information about treatment and metastases in ways that are effective in reaching target populations at risk for low levels of knowledge. Cancer prevention and control programs need to develop materials and strategies that are responsive to communities whose members are predominantly African Americans or blue collar workers, or have low levels of education and income.

Black or African American↗
PubMed1991

The effect of a stiff spinal implant on the bone-mineral content of the lumbar spine in dogs.

The response of canine lumbar vertebral bone to the application of a stiff transpedicular screw-plate implant from the third to the fifth lumbar vertebra, without arthrodesis, was investigated. Five groups of six dogs each were studied: dogs that had not had an operation (control group); dogs that had had a sham operation, with survival periods of three and six months; and dogs that had received an implant, with survival periods of three and six months. The results were the same in specimens from the control group and the group that had had a sham operation. In the groups that had received an implant, dual-photon absorptiometry revealed an insignificant decrease in bone-mineral content at the bypassed fourth lumbar segment (17 per cent at three months and 12 per cent at six months). When the data for the three and six-month intervals were pooled, the mean decrease in bone-mineral content of 14 per cent was significant. Histomorphic study yielded similar results; the mean decrease in bone-mineral content for the pooled three and six-month specimens was significant (16 per cent). Losses were similar for the ventral and dorsal columns. Histomorphometric analysis also showed a significant (13 per cent) loss of bone-mineral content at the adjacent caudad (sixth lumbar) vertebra for the pooled three and six-month groups. The results of the methods of analysis of loss of bone-mineral content correlated strongly. Under these experimental conditions, a stiff spinal implant caused loss of bone-mineral content of the bypassed vertebral segment, although the loss was less than anticipated and did not increase between three and six months.

Absorptiometry, Photon↗