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Biomedical subjects

V M Rakoff

Publications and source records attributed to V M Rakoff.

10 recordsLinked to original sources
PubMed1983

ECT as a form of restraint.

ECT is controversial as a form of therapy, with lay and psychiatric objectors. Restraint is also controversial, though often necessary. The Ontario Mental Health Act of 1978 allows the psychiatrist to restrain patients without consent if there is risk of physical danger. The act mentions "chemical and mechanical" means. ECT is not dealt with as a form of restraint. A case is described of a manic male who during 2 episodes of psychosis presented a serious threat of assault to staff. The next of kin was reluctant to sign consent for "treatment" because of fear of the patient's later resentment. An application to the Review Board for permission to treat would have taken a week. On both occasions attempts to control the patient with chemotherapy were totally unsuccessful despite the use of rapid neuroleptization, paraldehyde, barbiturates and mechanical restraints. In both admissions 4 ECT given over 2 days produced rapid behavioural control. ECT was then discontinued because the patient declined to give consent for ECT as treatment and he no longer presented a threat. Medical and legal consultation were necessary and the consensus was that ECT as restraint may be justified on the basis of clinical judgment. In such cases ECT is safer, more reliable and more humane than chemotherapy or mechanical restraints. The authors discuss the current public and professional antipathy towards ECT. There is risk of death for the patient in circumstances where legal barriers prevent the appropriate use of electro-shock and a U.S. case is mentioned.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1981

Depression associated with cimetidine.

Over the past three years we have seen twelve patients who have become depressed while taking cimetidine. Clinically the depression is similar to that seen in a Primary Affective Disorder. Two representative cases are presented. It is suggested that cimetidine has precipitated a depressive reaction is vulnerable patients. Tricyclic antidepressants are effective in relieving the depression. It is postulated that cimetidine, by blocking H2 receptors in the CNS, produces an imbalance between H1 and H2. This imbalance may be an etiological factor in precipitating the depression. Tricyclic antidepressants have little effect on H2 but are potent H1 receptor blockers. This H1 blockade could restore the balance between H1 and H2, thereby relieving the depression.

Adult↗
PubMed1975

Predictions of therapeutic process and progress in conjoint family therapy.

Following initial diagnostic interviews with 20 families in an outpatient psychiatric clinic, a group of therapists made predictions of the anticipated responses of the families to therapy. Changes in family structure, organization, and transactional patterns were predicted with use of the Family Category Schema. The families' responses to the process of therapy was predicted in a questionnaire. The results showed poor predictions of response to process. However, a normative response picture of a family in therapy did emerge. Also, all predictions erred in the direction of underrating the overall effectiveness of conjoint family therapy.

Adolescent↗