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Biomedical subjects

R Manchanda

Publications and source records attributed to R Manchanda.

At least 37 records · Page 2Linked to original sources
PubMed2000

Preferred terms for users of mental health services among service providers and recipients.

OBJECTIVE: The terms used to refer to recipients of psychiatric services continue to be controversial. Terms in current use include "patient," "client," "consumer," and "survivor." In this study mental health service recipients and providers were surveyed about their preferences among these terms, and responses were analyzed to identify factors associated with various preferences. METHODS: A total of 550 service providers and 427 recipients at four sites in Ontario-two provincial psychiatric hospitals, a private mental health center, and a psychiatric unit of a general hospital-participated in a brief anonymous survey. RESULTS: Among service providers, 68.4 percent preferred the term "patient," 26.5 percent preferred "client," and.5 percent preferred "consumer." Logistic regression analysis showed that service providers' preferences were associated with age and gender. Among service recipients, 54.8 percent preferred the term "patient," 28.8 percent preferred "client," 7 percent preferred "survivor," and 2.8 percent preferred "consumer." Service recipients' preferences were associated with site, self-reported diagnosis, and employment status. CONCLUSION: The study results indicate lack of universality in preferences for terms for users of mental health services and suggest the need for dialogue about preferred terms between service providers and recipients.

Adult↗
PubMed2000

Auras, seizure focus, and psychiatric disorders.

OBJECTIVE: The goal of this study was to assess the types of auras and their associations with the focus of seizures in 144 consecutive adult patients with partial epilepsy refractory to medical treatment. The association of frequency and type of aura with a psychiatric disorder was also studied. BACKGROUND: The nature of the aura, its association with the seizure focus, and its relation with emotions and behavioral dysfunction have received relatively little attention, and remain controversial. METHODS: Patients were admitted to an epilepsy investigation unit for detailed observation of their seizures and type of aura. Patients underwent standard electroencephalographic telemetry, including implanted subdural electrodes, if necessary, to delineate the seizure focus. The auras were classified into nine categories. All patients had an independent clinical psychiatric interview for a Diagnostic and Statistical Manual, Third Edition-Revised (DSM-III-R)-based diagnosis. RESULTS: Of the 144 patients studied, 111 (77.1%) had one or more symptoms during the aura and 33 (22.9%) had no aura. The most frequent aura types were viscerosensory (47 cases [32.6%]), experiential (44 cases [30.6%]), and cephalic (21 cases [14.6%]). A temporal lobe focus was present in 116 (80.5%) patients. Only experiential auras were significantly associated with a temporal lobe seizure focus (33 of 44 cases). A DSM-III-R psychiatric diagnosis was present in 74 (51.4%) patients. Of the 116 patients with a temporal lobe focus, 60 (50.2%) had a DSM-III-R psychiatric diagnosis. Patients with two or more auras were significantly more likely to have a psychiatric diagnosis (70.2%) compared with those with one aura (39.1%) or no aura (48.5%). A significant association between experiential auras and psychiatric morbidity was seen. CONCLUSIONS: Auras occurred in a majority of patients with a treatment-refractory partial epilepsy who were hospitalized for assessment of their seizure focus for possible surgical candidacy. Two or more auras were associated with a psychiatric diagnosis as was the presence of an experiential aura. Experiential auras were most common in temporal lobe epilepsy. Approximately half the patients, irrespective of seizure focus, had an associated psychiatric morbidity.

Adolescent↗
PubMed2000

Neuromuscular blocking effects of an alkaloidal extract from Inula royleana: contractile and electrical studies on amphibian skeletal muscle in vitro.

The neuromuscular blocking properties of an alkaloidal extract from the root of Inula royleana have been investigated in vitro using a combination of mechanical and electrophysiological approaches. Neurogenic twitches of the frog sartorius were profoundly inhibited by concentrations of the extract > or = 20 micrograms/ml, being reduced to 50% of control amplitude in approximately 90 s at a concentration of > or = 20 micrograms/ml. They were partially reversed by neostigmine (6 micrograms/ml), and by prolonged washout of the extract. Muscle surface action potentials, recorded with extracellular electrodes, also declined rapidly in amplitude in the presence of the extract. Direct muscle stimulation during inhibition by the extract elicited contractions and action potentials whose magnitudes were similar to control responses. Resting membrane potentials, and the intracellular input impedance of the skeletal muscle cells, were not significantly changed by the alkaloids. These results indicate that the extract has significant neuromuscular blocking activity of a partially or slowly reversible nature. The block appears to be exerted at the postjunctional end-plate nicotine receptors, thus offering promise for the identification of novel cholinergic receptor antagonist(s).

Action Potentials↗
PubMed1999

Quantal evoked depolarizations underlying the excitatory junction potential of the guinea-pig isolated vas deferens.

1. The effects of a putative gap junction uncoupling agent, heptanol, on the intracellularly recorded junction potentials of the guinea-pig isolated vas deferens have been investigated. 2. After the stimulation-evoked excitatory junction potentials (EJPs) had been suppressed by heptanol (2.0 mM) to undetectable levels, a different pattern of evoked activity ensued. This consisted of transient depolarizations that were similar to EJPs in being stimulus locked and in occurring at a fixed latency, but differed from EJPs in that they occurred intermittently and had considerably briefer time courses. 3. Analysis of the amplitudes and temporal parameters of the rapid residual depolarizations revealed a close similarity with spontaneous EJPs (SEJPs). There was no statistically significant difference between the rise times, time constants of decay and durations of the rapid residual depolarizations and of SEJPs. 4. Selected evoked depolarizations were virtually identical to SEJPs occurring in the same cell. Evoked depolarizations of closely similar amplitude and time course also occurred, usually within a few stimuli of each other. 5. These depolarizations appear to represent the individual quantal depolarizations that normally underlie the EJP and are therefore termed 'quantal excitatory junction potentials' (QEJPs) to distinguish them from both EJPs and SEJPs. 6. We examined the possibility that heptanol revealed QEJPs by disrupting electrical coupling between cells in the smooth muscle syncytium. Heptanol (2.0 mM) had no effect on the amplitude distribution, time courses, or the frequency of occurrence of SEJPs. Intracellular input impedance (Rin) of smooth muscle cells was left unaltered by heptanol. 7. 'Cable' potentials of the vas deferens, recorded using the partition stimulation method, also remained unchanged in the presence of heptanol. Thus, heptanol appeared not to modify syncytial electrical properties of the smooth muscle in any significant way. 8. Our observations show directly that the quantal depolarizations underlying the EJP in syncytial smooth muscle are SEJP-like events. However, no unequivocal statement can be made about the mechanism by which heptanol unmasks QEJPs from EJPs.

Animals↗
PubMed1999

A Canadian multicenter, double-blind study of paroxetine and fluoxetine in major depressive disorder.

BACKGROUND: Recent studies have suggested clinical differences among selective serotonin reuptake inhibitors. In a 12-week randomized, multicenter, double-blind trial, the antidepressant and anxiolytic efficacy of the selective serotonin reuptake inhibitors paroxetine and fluoxetine was compared in patients with moderate to severe depression. METHODS: A total of 203 patients were randomized to fixed doses (20 mg/day) of paroxetine or fluoxetine for the first six weeks of therapy. From week 7-12, dosing could be adjusted biweekly, as required (paroxetine 20-50 mg/day, and fluoxetine 20-80 mg/day). The mean prescribed doses were paroxetine 25.5 mg/day (range 20.0-40.2 mg/day), and fluoxetine 27.5 mg/day (range 20.0-59.5 mg/day). Emergence of motor nervousness or restlessness was assessed using the ESRS scale for akathisia. RESULTS: Both active treatments demonstrated comparable antidepressant efficacy (HAM-D, CGI). Anxiolytic activity of the two drugs (COVI, STAI, HAM-D) was also comparable. However, paroxetine was found to be superior to fluoxetine on two subscore measures at week 1 of therapy (HAM-D Agitation item, p < 0.05; Psychic Anxiety item, p < 0.05), with no differences detected after week 2. The overall incidence of adverse effects was comparable in the two treatment groups. Constipation, dyspepsia, tremor, sweating and abnormal ejaculation were more common in paroxetine-treated subjects, whereas nausea and nervousness were more frequent in fluoxetine-treated patients. Weight loss was more common in the fluoxetine versus paroxetine group (11.88% versus 2.94%, respectively). ESRS scores for akathisia were low throughout the study and showed little change. LIMITATIONS: Differences observed between the two drugs in antianxiety effects were limited to two measures of anxiety among several others. DISCUSSION: The data indicate that paroxetine and fluoxetine have comparable antidepressant and anxiolytic efficacy. Paroxetine appears to produce an earlier improvement in agitation and psychic anxiety symptoms compared with fluoxetine.

Adult↗
PubMed1999

Effects of heptanol on the neurogenic and myogenic contractions of the guinea-pig vas deferens.

1. The effects of the putative gap junction uncoupler, 1-heptanol, on the neurogenic and myogenic contractile responses of guinea-pig vas deferens were studied in vitro. 2. Superfusion of 2.0 mM heptanol for 20-30 min produced the following reversible changes in the biphasic neurogenic contractile response (8 trials): (i) suppression of both phases; (ii) delayed development of both the first as well as the second phase, accompanied by complete temporal separation of the two phases; (iii) prominent oscillations of force during the second (noradrenergic) phase only. 3. To eliminate prejunctional effects of heptanol, myogenic contractions were evoked by field stimulation of the vas in the presence of suramin (200 microM) and prazosin (1 microM). Heptanol (2.0 mM) abolished these contractions reversibly. 4. These results show that (i) heptanol inhibits both excitatory junction potential (EJP)-dependent and non EJP-dependent contractions of the vas; (ii) a postjunctional site of action of heptanol, probably intercellular uncoupling of smooth muscle cells, contributes to the inhibition of contraction.

Adenosine Triphosphate↗
PubMed1999

The treatment of negative symptoms: a clinical and methodological study.

The primary objective of this study was to evaluate the efficacy, safety and tolerability of remoxipride (controlled release) versus haloperidol in patients with negative symptoms. The study comprised a multicentre, randomised, double-blind, parallel-group clinical trial. Two hundred and five patients were randomised to either remoxipride or haloperidol. Patients eligible for this study were aged 18-65 years, met the DSM-III-R diagnosis for chronic schizophrenia and the Positive and Negative Symptoms Scale (PANSS) criteria for predominant negative symptoms. There was a statistically significant reduction in the PANSS scores of at least 20% from baseline to last rating for 39 remoxipride (49.4%) and 45 haloperidol (47.6%) treated patients. There were no statistical differences found between the two treatment groups with respect to improvement of negative symptoms and adverse events. The PANSS data suggest that both remoxipride and haloperidol improve the cluster of negative symptoms concerned with social functioning. In addition, the design of the study provides a methodology that is appropriate to the study of primary negative symptoms in schizophrenia.

Adult↗
PubMed1997

Effects of heptanol on electrical activity in the guinea-pig vas deferens.

1. The effects of the putative intercellular uncoupling agent I-heptanol on electrical activity in the guinea-pig vas deferens were studied by use of intracellular and extracellular recording techniques. 2. At concentrations of 0.5, 1 and 2 mM, heptanol rapidly, monotonically and reversibly attenuated intracellularly recorded excitatory junction potential (e.j.p.) amplitude without affecting its time course, while spontaneous excitatory junction potentials (s.e.j.ps) were left unaffected. 3. Heptanol did not affect either the extracellularly recorded evoked excitatory junction current (e.j.c.), or the nerve terminal impulse that preceded it. These observations indicate that heptanol does not affect nerve impulse conduction, neurotransmitter release, or the postjunctional receptors involved in the production of the e.j.p. 4. E.j.ps appear to be suppressed by heptanol due to its intercellular uncoupling effects. Therefore, functional intercellular coupling may be necessary for the generation of the e.j.p. in smooth muscle.

Alcohols↗
PubMed1996

Psychiatric disorders in candidates for surgery for epilepsy.

OBJECTIVE: To provide a descriptive analysis of the prevalence and pattern of psychiatric morbidity among 300 consecutive epileptic patients refractive to treatment and admitted during a six year period for evaluation of their candidature for surgery. METHODS: Patients underwent detailed observation of their seizure and standardised psychiatric assessment. Patients were considered to be refractory to treatment if they continued to manifest seizures with an average frequency of at least once every month even with polytherapy using up to three different anti-convulsants for a period of at least two years. Of the 300 patients, 231 had a temporal lobe focus, 43 had a non-temporal lobe focus, and 26 patients had a generalised and multifocal seizure onset. RESULTS AND CONCLUSIONS: With the DSM-III-R criteria 142 (47.3%) patients emerged as psychiatric cases. A principal axis I diagnosis was made in 88 (29.3%), and an axis II diagnosis (personality disorder) in another 54 (18.0%) patients. The most common axis I diagnosis was anxiety disorders (10.7%). A schizophrenia-like psychosis was seen in 13 (4.3%). Most patients with personality disorders showed dependent and avoidant personality traits. There was a significantly higher psychotic subscore on the present state examination in the temporal than with the non-temporal group of patients. These findings were not significant when compared with patients with a generalised and multifocal seizure disorder. There were no significant findings between the different seizure focus groups on the neurotic subscores. The findings with regard to laterality of seizure focus and the neurotic or psychotic subscores were not significant.

Adult↗
PubMed1995

Transforms of the computerized patient record data model: from transactions to analytical processing.

The design of Computerized Patient Record databases needs to be different depending on whether the focus of the database is transaction processing or analytical processing. Transaction processing includes the operational use of databases for single patient update during clinical encounters. Analytical processing includes cross-patient querying for research or clinical management. These different design needs are defined. A case study is presented for the methodology that transforms transaction databases to analytical ones. The resulting analytical design is argued to be successfully evaluated according to specific criteria of useability and maintainability. This methodology is easily replicated in any relational database environment.

Computer Systems↗
PubMed1993

Post-ictal psychosis after right temporal lobectomy.

Of 298 patients who had temporal lobectomies for intractable epilepsy, 4 (1.3%) developed post-ictal psychosis for the first time after surgery. All were males of normal intelligence with no pre-operative psychiatric disorder. Psychosis followed both complex partial and generalised seizures. The psychotic symptoms showed polymorphic features. Right temporal lobectomy may increase the susceptibility to post-ictal psychosis in patients who are not seizure free after surgery, particularly in the first post-operative year.

Adult↗
PubMed1992

Sexual abuse and psychiatric symptoms in an epileptic population.

One hundred and seven consecutive patients attending the outpatient epilepsy clinic at a teaching general hospital were assessed by clinical interview for a history of sexual abuse. Questionnaires dealing with overall psychiatric symptomatology i.e., (SCL-90), (TSC-40) and depression (ZSRDS) were also used. The majority of subjects were single (60%), living at home (76.6%) and had an average age of 29 years. The mean duration of epilepsy was 18.8 years and the seizures were controlled with medication in 65.2% of patients. Ten (9.3%) of the subjects had been sexually abused. This frequency of sexual abuse is lower than in the general population and among psychiatric patients. The specific form of sexual abuse consisted of sexual intercourse (n = 4), fondling (n = 4) and oral sex (n = 2). The sexually abused subjects had significantly higher scores on the anxiety subscale of the SCL-90 and depression score on the ZSRDS than non-abused subjects.

Adolescent↗
PubMed1992

Neuroleptic malignant syndrome: a preventive program.

Neuroleptic Malignant Syndrome is a very serious side effect of antipsychotic medications. The paper describes a preventative program which was instituted in an inpatient unit of a provincial psychiatric hospital. There have been no mortalities from Neuroleptic Malignant Syndrome (NMS) during this program. A suspicion of NMS by clinical evaluation and laboratory tests resulted in prompt management. The recommended management plan is described.

Adult↗
PubMed1991

Psychiatric patients and the federal election.

A questionnaire was sent to all eligible voters at the St. Thomas Psychiatric Hospital prior to the November 1988 election. It measured political awareness and knowledge. A further subgroup of patients who were eligible to vote but chose not to be enumerated were also questioned to explore their reasons for not voting. The results showed patients had a high level of knowledge about our political process. We conclude that previous laws banning voting by psychiatric patients were unnecessarily discriminatory and efforts should be made to give voting rights to patients in other countries where they are not allowed to vote.

Awareness↗