Biomedical subjects
V Rippere
Publications and source records attributed to V Rippere.
'Hysteria', 'functional' or 'psychogenic'?
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Possible steroid withdrawal syndrome following short Synacthen test--a personal report.
Symptoms not attributable either to disease rebound or to adrenal suppression have been reported both in patients receiving steroids when long-term therapy has been stopped and in normal volunteers after single oral doses of prednisolone or intravenous equivalents. This so-called steroid withdrawal syndrome remains poorly understood. It has not previously been reported following exposure to increased levels of endogenous steroids after diagnostic administration of synthetic adrenocorticotrophic hormone (ACTH). The author's personal experience of an apparent steroid withdrawal reaction following a short Synacthen test is described. It is suggested that as yet unidentified individual factors must play a role in determining whether steroid withdrawal symptoms occur. Closer observation of other subjects after the Synacthen test might reveal other instances of steroid withdrawal symptomatology following this common diagnostic procedure.
Inactive ingredients in medicines.
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Euthyroid hyperthyroxinaemia.
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Hypothalamic hypothyroidism with end-organ resistance--further personal observations.
Further personal observations are made of the case of hypothalamic hypothyroidism with end organ resistance described in an earlier report. The course of the disorder on replacement therapy appears to be a relapsing one, with relapses provoked by seasonal changes and physical stresses. The relapses remit with increased doses of thyroid replacement. There is some evidence of increased levels of reverse T3 prior to T3 replacement and also evidence suggestive of a parallel hypothalamic hypoadrenal deficit.
Thyroxine replacement treatment: clinical judgment or biochemical control?
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'Psychic sensitivity', mystical experience, head injury and brain pathology.
The 'psychic' experiences of 17 students (sensitives) from the College of Psychic Studies were compared with those of 17 church-going control subjects, who were matched for age, sex, and approximate intellectual level. At interview, 67 items of information relating to the medical history, family history, 'psychic gifts', head injuries, and mystical experiences were obtained. The shortened WAIS, the Benton Visual Retention Test, with tests of both dominant (Wechsler Logical Memory) and non-dominant temporal lobe function (the Rey-Osterreith Test) were given. The results showed that the sensitive population contained more single or divorced people, and people who had sometime consulted a psychiatrist. They had experienced more head injuries and serious illnesses than the controls. Sixty-six per cent showed evidence of right hemisphere and right temporal lobe dysfunction and, of these, 35 per cent had poor visual memories. There was evidence to suggest that some 'psychic' experiences were associated with brain dysfunction. Despite an increased occurrence of head injury, no clear correlation with the onset of 'psychic' sensitivity was found. Mystical experiences showed a trend towards being related to non-dominant hemisphere dysfunction. Vagueness about the position of the sensitive's 'psychic helper' in physical space was also associated with non-dominant hemisphere dysfunction.
Validity of alternative allergy practices.
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Can hypoglycaemia cause obsessions and ruminations?
Two cases of obsessional ruminations apparently secondary to functional hypoglycaemia are described. Both patients are young Caucasian males with obsessional histories at the start of dietary treatment of 18 and 6 years, respectively. In both cases, reactive hypoglycaemia was confirmed by glucose tolerance test. The first case made a complete recovery on dietary treatment which has lasted over two years; previous treatment with drugs, behaviour therapy, and counselling were unsuccessful The response of the second case has been less outstanding due to poor compliance, but improvement and worsening have been systematically related to the extent of his adherence to the suggested dietary regimen. These cases raise questions for further research on this neglected subgroup of obsessional patients.
Some varieties of food intolerance in psychiatric patients: an overview.
Foods may cause mental and behavioural symptoms by means of a variety of mechanisms. Food allergy is only one of many of these. The paper presents a brief overview of evidence, as of early 1982, concerning cerebral allergy, food addiction, the hypoglycaemias, caffeinism, hypersensitivity to chemical food additives, reactions to vasoactive amines in foods, and reactions attributed to neuropeptides formed from foods as causes of mental symptoms, with particular reference to psychiatric patients. It is concluded that although much work in this field remains to be done, enough is already known to benefit patients now if available knowledge is applied. An individual-centred environmental approach, extending beyond dietary factors if necessary, is recommended as more likely to help than a group-centred paradigm-based approach to treatment.
Food allergy: how much in the mind?
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What's the thing to do when you're feeling depressed? A cross-cultural replication.
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What makes depressed people feel worse? A cross-cultural replication.
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Biochemical victims: false negative diagnosis through overreliance on laboratory results--a personal report.
The increasing tendency of doctors to base diagnosis on the results of laboratory investigations entails a corresponding decrease in the exercise of clinical judgment. This state of affairs can have harmful consequences for patients suffering from biochemically atypical forms of disorder, who may acquire functional psychiatric labels when they are in fact suffering from organic physical disorders. The author's personal experience of this invidious predicament is described. Although hypothyroidism was correctly diagnosed on clinical grounds within a few months of presentation, laboratory results were inconclusive and three years and three specialist consultations were to elapse before replacement therapy was obtained, and then only through unofficial channels. The handling of this case illustrates some unfortunate trends in contemporary medical practice with important implications for the health of patients.
Food additives and hyperactive children: a critique of Conners.
Food Additives and Hyperactive Children (Conners, 1980) is the first book-length attempt to evaluate Feingold's additive and salicylate-free Kaiser-Permenente diet for the treatment of hyperactive children, and as such it requires critical scrutiny. The studies reported in the book appear to be open to criticism from a number of points of view. It is argued that the studies as reported do not constitute a methodologically adequate test of Feingold's hypothesis that many hyperactive children are hypersensitive to artificial colours and flavours and other chemical additives and naturally occurring substances in foods and that it is thus premature to reject the hypothesis on the grounds presented here. It is argued, further, that Feingold's approach to the environmental aetiology of childhood hyperactivity is too limited and may for this reason lead to a failure to discover and eliminate other possible environmental causes of this increasingly prevalent condition.
Dietary treatment of chronic obsessional ruminations.
Chronic obsessional ruminations may prove resistant to psychological treatment because they are not psychological in nature but epiphenomena of brain dysfunction secondary to nutritional factors. The case is described of a chronic, treatment-resistant ruminator who made a dramatic and lasting recovery when a high protein breakfast was added to his elimination diet regimen, undertaken when years of psychological and pharmacological treatment had failed. Biochemical and clinical evidence supports the hypothesis that hypoglycaemia secondary to inappropriate diet was the cause of his disorder. Dietary contributions to obsessional ruminations should probably be sought early on in the assessment of such patients.