Benefits of a nurse-psychiatrist collaborative practice in an anxiety disorders unit.

1 Only one out of four people receives the appropriate therapy for anxiety disorders, despite available and effective treatments. 2 Nurse-doctors collaborative practice is a working relationship with a sharing of responsibilities of the treatment program within the realm of respective roles. 3 Using an evidence-based care approach allowed the care providers to continually monitor, assess and revise the treatment program which proved to be cost effective and time efficient, yet provided premium patient care.

Adrenal gland weight and suicide.

The purpose of this study is to determine if there is an anatomical correlate, namely adrenal hypertrophy, among people who have committed suicide. The adrenal weights and other relevant information were collected prospectively from 118 consecutive coroner's cases of sudden death in the province of Ontario. No statistically significant difference was found between the adrenal weights of those who had committed suicide, whether violent or non violent, and those dying suddenly of causes not self-inflicted. This was true irrespective of the age of the subjects, their sex or the centre at which the autopsy was performed. This finding does not support the findings of an earlier report of increased adrenal weight in successful suicides. The incidental finding of increased adrenal weight in all subjects is of some significance.

Anxiety-related reactions associated with magnetic resonance imaging examinations.

OBJECTIVE: To review the epidemiology of anxiety-related reactions during magnetic resonance imaging (MRI) examinations, the feasibility of identifying patients at risk, and the management strategies that have been applied. DATA SOURCES: Published original articles were retrieved using computerized MEDLINE searches encompassing 1980 through April 1993. Further references were obtained from the primary sources. STUDY SELECTION AND DATA EXTRACTION: All studies obtained through the data search were chosen for review. All data relevant to anxiety-related reactions were analyzed. DATA SYNTHESIS: Anxiety-related reactions occur in approximately 4% to 30% of patients undergoing MRI, ranging from apprehension to severe reactions that interfere with the performance of the test. Criteria for diagnosis or categorization of the reactions and identification of patients at risk are scanty. Several management strategies have been proposed, including patient education, drug therapy, and cognitive-behavioral intervention. CONCLUSIONS: While a more precise characterization of the nature and incidence of anxiety-related reactions during MRI examinations and better methods of recognizing patients at risk are desirable, a strategy for general and individual prophylaxis, identification of patients at risk, and individual patient management can be developed on the basis of current knowledge.

Four cases of progressive supranuclear palsy in patients exposed to organic solvents.

Four cases are described in which Progressive Supranuclear Palsy (PSP) is associated with the use of organic solvents. Two of them are a housewife and an exbanker who had multiple exposure to insecticides (with organic solvent base), followed years later with a diagnosis of PSP. The other two are of lithographers, both of whom worked at the same industrial firm where solvent exposure took place with subsequent development of PSP. The hypothesis that PSP is linked to an environmental toxin is supported by these cases.

Antidepressant medication reverses increased sensitivity to light in depression: preliminary report.

1. Sensitivity to blue light was quantified using a Friedman Central Field Analyzer and the Dark Adaptation Threshold procedure. 2. Patients diagnosed as having a major depressive disorder using research diagnostic criteria had dark adaptation thresholds quantified after a 10 day drug wash out and again after antidepressant drug therapy. 3. Prior to drug treatment patients were significantly more sensitive to light than controls as measured by cone but not rod thresholds. 4. Following drug treatment both cone and rod thresholds were reduced in patients. In comparison to controls, drug treatment normalized cone threshold and reduced rod threshold in patients. 5. These data provide ophthalmological evidence for increased sensitivity to light in non medicated depressive disorder and a reduction in sensitivity following antidepressant drug therapy. 6. The possibility of altered retinal function and consequently the ability to perceive and use light for entrainment of circadian rhythm in affective disorder deserves further study.

Dysthymia: a randomized study of cognitive marital therapy and antidepressants.

Preliminary data from a randomized study of the effectiveness of combined marital therapy and antidepressant medication in the treatment of dysthymic married women is presented. The study compares doxepin with placebo, and a marital therapy designed to enhance intimacy through facilitating self-disclosure between spouses with a more supportive and educational therapeutic approach. After ten weeks of combined treatment, the dysthymic women show statistically significant improvement on all the depression measures as well as on the intimacy scale. A trend is developing for greater reduction of depressive symptomatology in the group treated with self-disclosure. The evidence appears to suggest the possibility that the presence of a patient's husband as a supportive figure may of itself be a potent therapeutic manoeuvre in the treatment of dysthymic women.