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1.
Ir J Psychol Med ; 40(3): 323-325, 2023 09.
Article in English | MEDLINE | ID: mdl-34847969

ABSTRACT

This paper considers recent research on suicide risk assessment to support calls for a 'rethink' of our assessment of the patients in our care, along with the adoption of a more collaborative approach to care planning with service users who remain at risk of self-harm and in need of a plan for their safety.


Subject(s)
Self-Injurious Behavior , Suicide , Humans
2.
Ir J Med Sci ; 183(2): 277-81, 2014 Jun.
Article in English | MEDLINE | ID: mdl-23959770

ABSTRACT

OBJECTIVE: To describe the relationship between parents with gender identity disorder (GID) and their child(ren) as described by the parent and to understand how being a parent affects transitioning from one gender to the other. METHODS: Fourteen parents with GID underwent a semi-structured interview and completed the Index of Parental Attitudes (IPA). An IPA score of greater than 30 indicates parent­child relationship difficulties (range 0­100). The authors also conducted the SCID-I to establish other Axis I disorders. RESULTS: We assessed 12 male to female and two female to male parents with GID residing in Ireland. In total, 14 GID parents had 28 children. Three children had no relationship with their GID parent. The other 25 children, as reported by the parent, had good relationships with their children. In addition, these 25 children average score IPA score was 6.4 (range 0­25). Twelve GID parents (86 %) believed that being a parent had no effect on their desired level of transitioning, while two were influenced not to transition. Eleven GID parents (79 %) reported that being a parent had increased the time taken to commence transitioning, two have stopped transitioning altogether, while one cited no effect on time. CONCLUSION: Parents with GID report positive relationships or no relationship with their children and the IPA revealed no clinical problems. Being a parent can prolong transitioning time in people with GID and can affect overall achieved level of transitioning.


Subject(s)
Child of Impaired Parents/psychology , Parent-Child Relations , Transgender Persons/psychology , Transsexualism/psychology , Adolescent , Adult , Adult Children/psychology , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult
3.
Ir J Psychol Med ; 30(2): 131-134, 2013 Jun.
Article in English | MEDLINE | ID: mdl-30199970

ABSTRACT

This paper provides a description of a structured template which allows review of the operation of the Mental Health Act 2001 at St Patrick's Mental Health Services (incorporating St Patrick's University Hospital, St Edmundsbury Hospital and Willow Grove Adolescent Unit). These structured processes were implemented to ensure rigorous monitoring of all clinical governance activities associated with adherence to the Mental Health Act (MHA) 2001. The paper describes in detail the information contained in the St Patrick's Mental Health Services dashboard for 2012. The dashboard displays the key performance indicators that are monitored and the paper describes how these were reviewed by the Hospital's Clinical Governance Committee on a weekly basis for the three approved centres. The dashboard has also been used by the Clinical Governance Committee to provide ongoing education and engagement with staff in order to improve the operation of the MHA 2001. The use of this structured monitoring process has allowed the hospital to measure adherence to the MHA 2001 and also to measure activities that impact directly on the care and treatment of patients detained under the Act. The use of structured monitoring tools (i.e. the dashboard) to review the operation of the MHA 2001 allows for coherent observation of key events and issues which can cause concern in terms of the operation of the Act.

4.
Ir J Med Sci ; 172(4): 195-201, 2003.
Article in English | MEDLINE | ID: mdl-15029989

ABSTRACT

BACKGROUND: Risperidone and olanzapine are thought to have similar clinical effects. This study was designed to compare costs of treatment. AIM: To compare costs of treatment with risperidone or olanzapine in a naturalistic setting. METHOD: The Irish Risperidone Olanzapine Drug Outcomes studies in Schizophrenia (RODOS) programme was a retrospective review of medical notes and prescription charts in 396 inpatients with schizophrenia or schizoaffective disorder. The main outcome measure was cost of inpatient drug treatment. RESULTS: There was no statistical difference in length of hospital stay between risperidone-treated and olanzapine-treated patients (mean duration of stay 37.8 and 40.5 days, p=0.90). Mean+/-SD doses of risperidone and olanzapine were 4.2+/-2.1 mg/day and 12.9+/-5.0 mg/day, respectively. Average daily cost of all inpatient drugs was significantly higher for olanzapine than for risperidone (i.e. IEP5.61 [7.12] vs IEP3.38 [4.29]; p<0.0001), as was mean total costs of all inpatient drugs (i.e. IEP114.8 [145.8] vs IEP62.0 [78.7]; p<0.0001). This partly reflected the mean, non-significant, longer treatment duration for olanzapine compared with risperidone (mean 30.0 vs 26.4 days; p=0.27). Concomitant neuroleptic use was similar for both groups (71% risperidone, 73% olanzapine; p=0.54). CONCLUSION: Risperidone was associated with significantly lower drug treatment costs.


Subject(s)
Antipsychotic Agents/economics , Antipsychotic Agents/therapeutic use , Benzodiazepines/economics , Benzodiazepines/therapeutic use , Drug Costs/statistics & numerical data , Risperidone/economics , Risperidone/therapeutic use , Schizophrenia/drug therapy , Adult , Cohort Studies , Cost-Benefit Analysis , Costs and Cost Analysis , Drug Administration Schedule , Drug Therapy, Combination , Drug Utilization , Female , Hospitalization , Humans , Ireland , Male , Olanzapine , Outcome Assessment, Health Care , Psychotic Disorders/drug therapy , Psychotic Disorders/economics , Retrospective Studies , Schizophrenia/economics , Treatment Outcome
6.
J Clin Psychiatry ; 61(12): 933-41, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11206599

ABSTRACT

BACKGROUND: This 7-day, randomized, open-label, multicenter, international study compared the efficacy and tolerability of intramuscular (i.m.) ziprasidone with haloperidol i.m. and the transition from i.m. to oral treatment in hospitalized patients with acute psychotic agitation (related to DSM-III-R diagnoses). METHOD: Patients received up to 3 days of flexible-dose ziprasidone i.m. (N = 90) or haloperidol i.m. (N = 42) followed by oral treatment to day 7. After an initial ziprasidone i.m. dose of 10 mg, subsequent i.m. doses of 5 to 20 mg could be given every 4 to 6 hours (maximum daily dose = 80 mg) if needed, followed by oral ziprasidone, 80-200 mg/day. Haloperidol i.m. doses of 2.5 to 10 mg were given on entry, followed by 2.5 to 10 mg i.m. every 4 to 6 hours (maximum daily dose = 40 mg) if needed, then by oral haloperidol, 10-80 mg/day. RESULTS: The mean reductions in Brief Psychiatric Rating Scale (BPRS) total, BPRS agitation items, and Clinical Global Impressions-Severity scale scores were statistically significantly greater (p < .05, p < .01, and p < .01, respectively) after ziprasidone i.m. treatment compared with haloperidol i.m. treatment. Further reductions in these scores also occurred in both groups following transition to oral treatment. Ziprasidone was associated with a lower incidence of movement disorders and a reduced requirement for anticholinergic medication during both i.m. and oral treatment compared with haloperidol. Movement disorder scale scores improved with ziprasidone i.m. and oral treatment, but deteriorated with haloperidol. Other adverse events were rare with both treatments. CONCLUSION: Ziprasidone i.m. was significantly more effective in reducing the symptoms of acute psychosis and was better tolerated than haloperidol i.m., particularly in movement disorders. The transition from ziprasidone i.m. to oral ziprasidone was effective and well tolerated.


Subject(s)
Antipsychotic Agents/administration & dosage , Haloperidol/administration & dosage , Piperazines/administration & dosage , Psychotic Disorders/drug therapy , Thiazoles/administration & dosage , Acute Disease , Adult , Aged , Antipsychotic Agents/adverse effects , Antipsychotic Agents/therapeutic use , Brief Psychiatric Rating Scale/statistics & numerical data , Drug Administration Schedule , Female , Haloperidol/adverse effects , Haloperidol/therapeutic use , Hospitalization , Humans , Injections, Intramuscular , Male , Middle Aged , Piperazines/adverse effects , Piperazines/therapeutic use , Psychotic Disorders/diagnosis , Psychotic Disorders/psychology , Severity of Illness Index , Thiazoles/adverse effects , Thiazoles/therapeutic use , Treatment Outcome
7.
Int Clin Psychopharmacol ; 13(5): 199-203, 1998 Sep.
Article in English | MEDLINE | ID: mdl-9817624

ABSTRACT

The high 5-HT affinity of some atypical antipsychotic agents is thought to contribute to their clinical efficacy. We examined central 5-HT responses in two groups of ten schizophrenic patients by measuring serum prolactin and cortisol responses to the neuroendocrine challenge D-fenfluramine. One group of patients with schizophrenia was tested after a 2-week neuroleptic free period. A similar group were tested after a mean of 12 weeks treatment with the atypical antipsychotic risperidone. A significant elevation of baseline serum prolactin levels, consistent with dopaminergic antagonism was seen after risperidone treatment. Significantly reduced 5-HT mediated serum prolactin responses were seen in risperidone treated patients. D-fenfluramine evoked serum prolactin responses were positively correlated with positive but not negative schizophrenic symptoms for all 20 patients. Risperidone treatment was associated with a significant functional in-vivo 5-HT antagonism similar to clozapine. 5-HT antagonism may contribute to the efficacy of risperidone against positive schizophrenic symptoms.


Subject(s)
Antipsychotic Agents/therapeutic use , Fenfluramine , Risperidone/therapeutic use , Schizophrenia/drug therapy , Selective Serotonin Reuptake Inhibitors , Serotonin/metabolism , Adult , Humans , Hydrocortisone/blood , Prolactin/blood , Psychiatric Status Rating Scales , Schizophrenia/metabolism , Time Factors
8.
Am J Psychiatry ; 155(6): 838-40, 1998 Jun.
Article in English | MEDLINE | ID: mdl-9619161

ABSTRACT

OBJECTIVE: The authors examined the effect of prolonged clozapine treatment on central serotonergic (5-HT) function in schizophrenia. METHOD: Prolactin responses to the 5-HT releasing agent d-fenfluramine were measured in two groups of 10 schizophrenic subjects. The first group was tested twice, before and after a mean of 10 weeks of clozapine treatment. The second group was tested after a mean of 20 months of clozapine treatment. RESULTS: The prolactin response was significantly blunted in these 20 patients treated with clozapine. There was a significant positive correlation between d-fenfluramine-evoked prolactin release and the overall positive symptom score and the hallucination and delusion subscores of the Scale for the Assessment of Positive Symptoms. CONCLUSIONS: Blunted 5-HT-mediated prolactin responses in schizophrenic patients receiving clozapine monotherapy for up to 20 months were correlated with reductions in positive symptoms. This suggests that 5-HT antagonism is relevant to clozapine's efficacy in alleviating hallucinations and other positive schizophrenic symptoms.


Subject(s)
Antipsychotic Agents/therapeutic use , Clozapine/therapeutic use , Hallucinations/drug therapy , Prolactin/blood , Schizophrenia/drug therapy , Serotonin Antagonists/therapeutic use , Adult , Antipsychotic Agents/pharmacology , Clozapine/pharmacology , Female , Fenfluramine/pharmacology , Hallucinations/psychology , Humans , Male , Psychiatric Status Rating Scales , Receptors, Serotonin/drug effects , Schizophrenia/blood , Schizophrenic Psychology , Serotonin Antagonists/pharmacology , Treatment Outcome
9.
Biol Psychiatry ; 42(9): 827-33, 1997 Nov 01.
Article in English | MEDLINE | ID: mdl-9347132

ABSTRACT

Acetylcholine is a neurotransmitter that has been implicated in the pathophysiology of major depression. This is supported by the enhanced growth hormone (GH) release in response to pyridostigmine (PYD) challenge in depressed subjects relative to healthy comparison subjects. The aim of this study is to examine the specificity of the PYD/GH challenge in the diagnosis of depression. Pyridostigmine 120 mg orally, was administered to a total of 116 physically healthy subjects. Growth hormone responses were studied in 38 patients with (DSM-III-R) major depression, 13 subjects with panic disorder, 9 subjects with schizophrenia, 10 recently detoxified alcoholics, and a comparison group of 46 healthy volunteers. Mean delta GH (the difference between basal and maximal GH following PYD) was significantly greater than comparison subjects in patients with major depression. Responses observed in patients with schizophrenia and alcohol dependence syndrome did not differ from the comparison group. Those patients with panic disorder and a high Hamilton depression score had an enhanced delta GH. The sensitivity of the PYD/GH test was 63% for major depression. These results indicate that the PYD/GH test may help distinguish depression from schizophrenia, alcohol-dependence syndrome, or panic disorder with a low Hamilton depression score.


Subject(s)
Depressive Disorder, Major/diagnosis , Human Growth Hormone/blood , Parasympathomimetics , Pyridostigmine Bromide , Administration, Oral , Adult , Agoraphobia/blood , Agoraphobia/diagnosis , Depressive Disorder, Major/blood , Female , Humans , Male , Mental Disorders/blood , Mental Disorders/diagnosis , Panic Disorder/blood , Panic Disorder/diagnosis , Psychiatric Status Rating Scales , Sensitivity and Specificity
10.
Br J Psychiatry ; 171: 346-50, 1997 Oct.
Article in English | MEDLINE | ID: mdl-9373423

ABSTRACT

BACKGROUND: We compared regional cerebral blood flow (rCBF) in three groups of patients with DSM-III-R anxiety disorders. METHOD: Fifteen patients with obsessive -compulsive disorder (OCD), 15 with panic disorder with agoraphobia (PA), and 16 with post-traumatic stress disorder (PTSD) and a similar group of healthy controls were assessed on brain-dedicated high-resolution SPET. RESULTS: MANOVA revealed significant rCBF differences between diagnostic groups (F = 4.4; d.f. = 3, 57; P = 0.007) and between cerebral regions (F = 6.4; d.f. = 1, 57; P = 0.01) in OCD and PTSD compared with PA and healthy controls, limited to bilateral superior frontal cortices and right caudate nuclei. Whole brain blood flow correlated positively with anxiety (r = 0.24, n = 46, P = 0.05). Beck depression scores correlated significantly negatively with left caudate rCBF (r = -0.24, n = 46, P = 0.05) and right caudate rCBF (r = -0.31, n = 46, P = 0.02). PTSD syndrome severity correlated significantly negatively with the left caudate (r = -0.49, n = 16, P = 0.03) and with right caudate rCBF (r = -0.7, n = 16, P = 0.001). CONCLUSIONS: Functional rCBF differences in anxiety disorders could relate to repetitive, intrusive, distressing mental activity, prominent in both OCD and PTSD.


Subject(s)
Agoraphobia/physiopathology , Cerebrovascular Circulation/physiology , Obsessive-Compulsive Disorder/physiopathology , Panic Disorder/physiopathology , Stress Disorders, Post-Traumatic/physiopathology , Adult , Agoraphobia/diagnostic imaging , Blood Flow Velocity , Female , Humans , Male , Obsessive-Compulsive Disorder/diagnostic imaging , Organotechnetium Compounds , Oximes , Panic Disorder/diagnostic imaging , Stress Disorders, Post-Traumatic/diagnostic imaging , Tomography, Emission-Computed, Single-Photon
11.
Psychiatry Res ; 74(1): 25-33, 1997 Mar 14.
Article in English | MEDLINE | ID: mdl-10710160

ABSTRACT

We compared regional cerebral blood flow (rCBF) in 15 patients with DSM IIIR obsessive-compulsive disorder (OCD), 15 patients with DSM IIIR panic disorder and 15 healthy controls matched for age, sex and hand preference, using uptake of technetium-99m-D,L-hexamethyl-propylene amine oxime (99mTc HMPAO), on single photon emission computerised tomography (SPECT). Caudate rCBF was significantly reduced in OCD patients compared to healthy subjects and panic disorder patients. When four patients were excluded from each group, right caudate rCBF remained significantly lower in OCD patients than in panic disorder patients or healthy subjects. The data suggest functional involvement of the right caudate nucleus is present in OCD.


Subject(s)
Caudate Nucleus/blood supply , Obsessive-Compulsive Disorder/diagnostic imaging , Tomography, Emission-Computed, Single-Photon , Adult , Anxiety Disorders/diagnostic imaging , Anxiety Disorders/physiopathology , Brain Mapping , Caudate Nucleus/diagnostic imaging , Cerebral Cortex/blood supply , Cerebral Cortex/diagnostic imaging , Female , Humans , Male , Middle Aged , Obsessive-Compulsive Disorder/physiopathology , Panic Disorder/diagnostic imaging , Panic Disorder/physiopathology , Reference Values , Regional Blood Flow/physiology , Technetium Tc 99m Exametazime
12.
Br J Psychiatry ; 170: 159-61, 1997 Feb.
Article in English | MEDLINE | ID: mdl-9093506

ABSTRACT

BACKGROUND: Panic disorder is associated with neuroendocrinological abnormalities, some of which overlap with those seen in major depression. To date, there has been little assessment of the role of cholinergic mechanisms in this disorder. METHOD: Sixteen patients with DSM-III-R panic disorder and an age and gender-matched comparison group were administered 120 mg of the acetylcholinesterase inhibitor pyridostigmine. Growth hormone (GH) responses over a three-hour period were monitored. RESULTS: Mean delta GH, the difference between basal and the maximum pyridostigmine levels, was significantly greater in patients with panic disorder than in the comparison group. CONCLUSIONS: This may reflect increased cholinergic responsivity in panic disorder.


Subject(s)
Growth Hormone/metabolism , Panic Disorder/metabolism , Pyridostigmine Bromide/metabolism , Adult , Female , Humans , Male
13.
Am J Psychiatry ; 154(1): 56-63, 1997 Jan.
Article in English | MEDLINE | ID: mdl-8988959

ABSTRACT

OBJECTIVE: Although there is evidence from postmortem studies suggestive of deficient inhibitory neurotransmission of gamma-aminobutyric acid (GABA) in schizophrenia, no direct in vivo evidence has been obtained to date. The authors used single photon emission computed tomography (SPECT) with iodine-123-labeled iomazenil ([123I]iomazenil), a radioligand that selectively binds with high affinity to the benzodiazepine subunit of the GABAA receptor complex in the human brain, to investigate the presence of benzodiazepine receptor abnormalities in the cerebral cortex of living subjects with schizophrenia. METHOD: Dynamic [123I]iomazenil SPECT was performed in 15 patients (14 patients with DSM-III-R schizophrenia and one with schizophreniform disorder) and 12 healthy subjects over a period of 2 hours. The time-integral method was used to generate ratios of "specific" to "nonspecific" [123I]iomazenil binding at equilibrium for several cortical regions. RESULTS: No overall between-group differences in benzodiazepine receptor binding were found, but significant correlations emerged between the severity of schizophrenic symptoms and [123I]iomazenil binding in limbic cortical regions: positive symptom scores were negatively correlated with benzodiazepine receptor binding in the left medial temporal region, and negative symptoms were inversely related to receptor binding in the medial frontal region. These correlations were not significant when a Bonferroni correction for multiple comparisons was applied. CONCLUSIONS: These preliminary results are consistent with previous research implicating limbic cortical regions in the pathophysiology of schizophrenia, suggesting that reduced inhibitory GABAergic tone in these areas may contribute to the appearance of schizophrenic symptoms.


Subject(s)
Cerebral Cortex/metabolism , Receptors, GABA-A/metabolism , Schizophrenia/diagnosis , Schizophrenic Psychology , Adolescent , Adult , Cerebral Cortex/diagnostic imaging , Female , Flumazenil/analogs & derivatives , Frontal Lobe/diagnostic imaging , Frontal Lobe/metabolism , Humans , Male , Psychiatric Status Rating Scales , Schizophrenia/diagnostic imaging , Schizophrenia/physiopathology , Severity of Illness Index , Temporal Lobe/diagnostic imaging , Temporal Lobe/metabolism , Tomography, Emission-Computed, Single-Photon , gamma-Aminobutyric Acid/physiology
14.
Br J Med Psychol ; 70 ( Pt 4): 403-11, 1997 Dec.
Article in English | MEDLINE | ID: mdl-9429759

ABSTRACT

We compared Wisconsin Card Sorting Task (WCST) performance in 19 obsessive-compulsive disorder (OCD) patients and 19 individually matched healthy controls. Measures of intelligence and mood were taken into account for all participants. Within the patient group, factors such as duration and severity of symptoms (as assessed using the Yale-Brown Obsessive-Compulsive Scale, Y-BOCS) were considered. We explored the relationship between OCD WCST errors and regional cerebral blood flow (rCBF) on brain dedicated, high resolution, single photon emission tomography (SPET). We used uptake of 99mTc-hexamethylpropylamine oxime (HMPAO) on SPET to estimate rCBF, and regional values were quantified as ratios of cerebellar blood flow. WCST results confirmed OCD patients were significantly impared when compared with age- and sex-matched healthy volunteers. Patients made significantly more trials, more preseverative errors, and more null-sorts. OCD patients Y-BOCS 'obsessive' subtotal significantly correlated with many WCST errors. Furthermore OCD WCST null-sorts correlated significantly with SPET OCD left inferior frontal cortical rCBF (r(18) = .47, p = .05) and left caudate rCBF (r(18) = .72, p = .01). The implications of these findings are discussed in the context of other studies which examine functional imaging and neuropsychology in OCD.


Subject(s)
Brain/blood supply , Obsessive-Compulsive Disorder/diagnostic imaging , Psychological Tests , Adult , Brain/diagnostic imaging , Female , Humans , Male , Middle Aged , Prospective Studies , Technetium Tc 99m Exametazime , Tomography, Emission-Computed, Single-Photon/methods
15.
Psychol Med ; 26(2): 353-9, 1996 Mar.
Article in English | MEDLINE | ID: mdl-8685291

ABSTRACT

Abnormalities in central serotonin function have been implicated in the pathogenesis of anorexia nervosa. It is difficult, however, to separate neuroendocrine abnormalities induced by weight loss and malnutrition from those related primarily to the disorder itself. To minimize these influences, this study assessed long-term weight restored anorexics. A correlation between persistent eating-related psychopathology, co-morbid illness and serotonin dysfunction was sought. Nine female weight-restored out-patients who had previously fulfilled DSM-III-R criteria for anorexia nervosa and nine healthy controls participated. Following baseline estimation, prolactin and cortisol responses to 30 mg p.o. of D-fenfluramine were measured over a 5 h period. Eating related psychopathology was assessed using the Eating Disorders Inventory and Eating Attitudes Test. Depressive and obsessional symptoms were measured using the Beck Depressive and Maudsley Obsessive-Compulsive Inventories respectively. The Tridimensional Personality Questionnaire assessed impulsivity. The weight-restored anorexic group exhibited persistent eating-related psychopathology and significant co-morbid symptomatology. There was no difference between long-term weight-restored anorexics and controls in their endocrine response to D-fenfluramine. Long-term weight-recovered anorexic subjects continued to exhibit behavioural and attitudinal disturbances characteristic of anorexia nervosa. The results suggest that abnormalities in 5HT activity do not contribute significantly to trait status in anorexia nervosa.


Subject(s)
Anorexia Nervosa/physiopathology , Body Weight/physiology , Fenfluramine , Selective Serotonin Reuptake Inhibitors , Serotonin/physiology , Administration, Oral , Adult , Anorexia Nervosa/psychology , Anorexia Nervosa/therapy , Comorbidity , Female , Follow-Up Studies , Humans , Hydrocortisone/blood , Obsessive-Compulsive Disorder/physiopathology , Obsessive-Compulsive Disorder/psychology , Obsessive-Compulsive Disorder/therapy , Personality Inventory/statistics & numerical data , Prolactin/blood , Psychometrics
16.
Psychiatry Res ; 61(4): 255-64, 1995 Nov 10.
Article in English | MEDLINE | ID: mdl-8748469

ABSTRACT

Single photon emission tomography with split-dose technetium-99m-d, l-hexamethyl-propylene amine oxime was used to measure regional cerebral blood flow (rCBF) during a memory-activation paradigm in a group of 18 medicated DSM-III-R schizophrenic patients. The relationship between clinical features of schizophrenia and rCBF patterns was examined. Increased blood flow to the left basal ganglia was revealed during activation in patients reporting hallucinations in the previous month, a finding that was not influenced by medication dose or other confounding variables. This result adds to previous functional imaging studies that have related basal ganglia abnormalities to hallucinatory phenomena and suggests that left basal ganglia hyperactivity may be relevant to an internal monitoring deficit responsible for the appearance of those symptoms in schizophrenia.


Subject(s)
Arousal/physiology , Auditory Perception/physiology , Brain/blood supply , Hallucinations/diagnostic imaging , Mental Recall/physiology , Schizophrenia/diagnostic imaging , Schizophrenic Psychology , Tomography, Emission-Computed, Single-Photon , Verbal Learning/physiology , Adult , Attention/physiology , Basal Ganglia/blood supply , Blood Flow Velocity/physiology , Dominance, Cerebral/physiology , Female , Hallucinations/physiopathology , Hallucinations/psychology , Humans , Male , Middle Aged , Neurocognitive Disorders/diagnostic imaging , Neurocognitive Disorders/physiopathology , Neurocognitive Disorders/psychology , Neuropsychological Tests , Organotechnetium Compounds , Oximes , Psychiatric Status Rating Scales , Regional Blood Flow/physiology , Schizophrenia/physiopathology , Technetium Tc 99m Exametazime
17.
Br J Psychiatry ; 167(5): 629-34, 1995 Nov.
Article in English | MEDLINE | ID: mdl-8564319

ABSTRACT

BACKGROUND: We tested whether cortical and subcortical regional cerebral blood flow (rCBF) differs between patients with obsessive-compulsive disorder (OCD) and healthy controls. We then explored the relationship between rCBF and OCD mental state. METHOD: Thirty out-patients from the Maudsley Hospital with OCD as defined in DSM-III-R were scanned at rest using brain-dedicated, high-resolution, single photon emission tomography. RCBF was measured as uptake of 99mTc-HMPAO in 15 regions of interest and compared with rCBF data in 30 healthy people matched for age, sex and handedness. Symptom ratings were obtained using standard measures on the scanning day. Principal components factor analysis identified two distinct clinical dimensions: obsessive-compulsive (OC) and anxious-avoidant (AA). These were correlated with patients' rCBF measurements, using Spearman's rank correlation coefficient, and multiple regression coefficients calculated. RESULTS: We found significant reductions in rCBF measurements of OCD patients compared with resting, healthy controls (F = 1.92, P = 0.04) in seven brain regions: the right and left superior frontal cortex, right inferior frontal cortex, left temporal cortex, left parietal cortex, right caudate nucleus and right thalamus. Regional differences were not secondary to generalised reduction in patients' brain perfusion. Reduced blood flow to the right inferior frontal cortex correlated significantly with illness severity (r = 0.37, P = 0.02). There was no relationship with age, age-of-onset, sex, handedness, depression or medication status. OC clinical dimension, concerning obsessions, compulsions and low mood, was significantly negatively correlated with left inferior frontal, medial frontal and right parietal rCBF. AA dimension, concerning anxiety and avoidance, was significantly positively associated with left and right superior frontal, right inferior frontal, medial frontal cortical, and right and left caudate and thalamic rCBF. CONCLUSIONS: rCBF differs significantly between resting OCD patients and healthy controls, and separate clinical dimensions are associated with functionally distinct rCBF patterns.


Subject(s)
Anxiety Disorders/diagnostic imaging , Brain/blood supply , Obsessive-Compulsive Disorder/diagnostic imaging , Tomography, Emission-Computed, Single-Photon , Adult , Aged , Anxiety Disorders/physiopathology , Anxiety Disorders/psychology , Arousal/physiology , Brain Mapping , Cerebral Cortex/blood supply , Diagnosis, Differential , Dominance, Cerebral/physiology , Female , Humans , Image Processing, Computer-Assisted , Male , Obsessive-Compulsive Disorder/physiopathology , Obsessive-Compulsive Disorder/psychology , Organotechnetium Compounds , Oximes , Regional Blood Flow/physiology , Technetium Tc 99m Exametazime
18.
Br J Psychiatry ; 166(5): 642-6, 1995 May.
Article in English | MEDLINE | ID: mdl-7620750

ABSTRACT

BACKGROUND: Clozapine is an effective antipsychotic that has high affinity for serotonin type 2 (5-HT2) receptors. The importance of 5-HT antagonism in the overall clinical efficacy of clozapine is unclear. Using a neuroendocrine strategy we tested the hypothesis that clinical response to clozapine is related to alteration in 5-HT function. METHOD: Ten treatment-resistant schizophrenic subjects were treated with clozapine for a mean of 10.3 (s.e. 0.9) weeks; d-fenfluramine (DFEN) challenge tests were performed before and after treatment with concurrent clinical ratings (BPRS, SAPS, SANS) made at the time of testing. RESULTS: All patients showed clinical improvement following treatment with clozapine. In addition, clozapine produced a significant attenuation of prolactin (PRL) and cortisol (CRT) response to DFEN challenge. Change in symptom ratings correlated significantly with reduction in PRL response to DFEN challenge. CONCLUSIONS: These data show that functional alterations occur in the 5-HT system following response to clozapine and lend support to studies suggesting that 5-HT is an important component to the spectrum of action of clozapine.


Subject(s)
Clozapine/therapeutic use , Fenfluramine , Hydrocortisone/blood , Prolactin/blood , Psychiatric Status Rating Scales , Schizophrenia/drug therapy , Schizophrenic Psychology , Adult , Clozapine/adverse effects , Female , Humans , Male , Receptors, Serotonin/drug effects , Receptors, Serotonin/physiology , Schizophrenia/blood
19.
Am J Psychiatry ; 151(11): 1701-3, 1994 Nov.
Article in English | MEDLINE | ID: mdl-7943465

ABSTRACT

The prolactin response to oral d-fenfluramine (30 mg) was measured in nine patients with late-onset Alzheimer's disease and in an elderly comparison group. The serotonin-mediated prolactin response was significantly greater in the patients with Alzheimer's disease than in the comparison group. This finding suggests that central serotonin responsivity is greater in Alzheimer's disease.


Subject(s)
Alzheimer Disease/blood , Fenfluramine/pharmacology , Prolactin/blood , Serotonin/physiology , Aged , Aged, 80 and over , Alzheimer Disease/diagnosis , Alzheimer Disease/physiopathology , Female , Geriatric Assessment , Humans , Male , Receptors, Serotonin/drug effects , Receptors, Serotonin/physiology , Stereoisomerism
20.
Pharmacopsychiatry ; 27(1): 23-6, 1994 Jan.
Article in English | MEDLINE | ID: mdl-8159779

ABSTRACT

The growth hormone (GH) response to the gamma amino butyric acid type B (GABA-B) receptor agonist baclofen was measured in 10 Caucasian out-patients with DSM-III-R obsessive compulsive disorder (OCD) and 10 healthy comparison subjects. The patients also underwent a dexamethasone suppression test. The GH response was similar in both groups and there was a low rate of dexamethasone non-suppression in the patients. The data do not suggest that GABA-B receptor dysfunction is a feature of obsessive anxiety.


Subject(s)
Baclofen/therapeutic use , Growth Hormone/blood , Obsessive-Compulsive Disorder/drug therapy , Receptors, GABA-B/physiology , Adult , Female , Humans , Male , Middle Aged , Obsessive-Compulsive Disorder/physiopathology
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