Pharmacological treatment of affective disorders: A review and guide for the non-medical practitioner

Mental health professionals who lack medical training may also lack knowledge and understanding of the potential utility of medications in the treatment of emotional disturbance. They may also lack information regarding the effects and side-effects of medications which their clients may already be taking, or be uncertain when the nature of their client's situation suggests a psychiatric assessment regarding drug therapy. This paper offers an educational review in one such area: the pharmacological treatment of depression. It includes a brief review of theories regarding the aetiology of affective disorder, examines the methodes, mechanisms and efficacy of anti-depressants, and draws conclusions regarding the appropriate use of pharmacological treatment.     

Premissary relevance

Premissary relevance is a property of arguments understood as speech act complexes. It is explicable in terms of the idea of a premise's lending support to a conclusion. Premissary relevance is a function of premises belonging to a set which authoritatively warrants an inference to a conclusion. An authoritative inference warrant will have associated with it a conditional proposition which is true— that is to say, which can be justified. The study of the Aristotelian doctrine of topoi or argument schemes may contribute to the task of identifying authoritative warrants.     

Heart rate--QT relationships during baroreceptor stimulation with diminished autonomic influence on the ventricles. Ventricular autonomic tone and QT interval.

The shortening of the QT interval of the electrocardiogram coincident with acceleration of heart rate and vice versa has been accepted for many years as evidence that the action potential duration and hence QT are necessarily dependent on heart rate. Exceptions to this rule have been attributed to the intervention of counteracting autonomic effects. In order to test this assumption, 26 conscious dogs divided into three groups were tested during baroreceptor stimulation by a bolus injection of phenylephrine. Seventeen dogs had been used in earlier studies in which they had undergone an experimental anterior myocardial infarction with apparent full recovery. A group of those dogs underwent beta-adrenergic blockade by intravenous atenolol 30 min prior to the baroreceptor activation. To test the intactness of the baroreceptor responses in the previously infarcted dogs, a third group of nine dogs that had had no prior myocardial infarction was included. All dogs were adapted to the laboratory environment and were not sedated during experiments. Simultaneous recordings of RR, QT interval, and phasic arterial pressure were made in all dogs before and during baroreceptor stimulation. In the normal group, and the previously infarcted group that received no atenolol, baroreceptor stimulation elicited a small (8/msec), but significant prolongation of the QT associated with a nearly 50% reduction in heart rate. The QT interval of the atenolol-treated dogs, although significantly more prolonged before stimulation, remained unchanged during the reflex. The data indicate that withdrawal of ventricular sympathetic tone may prolong the QT interval, thereby confirming the role of sympathetic innervation in the control of QT.(ABSTRACT TRUNCATED AT 250 WORDS)     

Low-dimensional chaos maps learning in a model neuropil (olfactory bulb).

Quantification of a chaotic system can be made by calculating the correlation dimension (D2) of the data that the system generates (Packard et al., 1980). The D2 algorithm, however, requires stationarity of the generator, a feature that biological data rarely reflect (Mayer-Kress et al., 1988). So we developed the "point correlation dimension" (PD2), an algorithm that accurately tracks D2 in linked data of different dimensions (Carpeggiani et al., 1991). We now present a mathematical argument that, for stationary data, individual PD2s converge to D2 and we demonstrate that the algorithm rejects contributions made by bursts of noise. Data were obtained from the surface of the olfactory bulb of the conscious rabbit (64 electrodes, 640 Hz each, 1.3 sec epochs) before and after presentation of a novel or habituated odor. D2 could be calculated in only 1 of 10 novel-odor trials, whereas PD2 could be calculated in all. Both algorithms indicated that a novel odor evokes a spatially uniform dimensional increase. The PD2 uniquely exhibited the dimensional decreases that occur during inspiration and the gradients of mean dimension present during the nonstimulated control state. These control gradients remained unchanged without odor experience, but showed spatially specific PD2 increases following odor habituation. It is interpreted that, 1) the PD2 is sensitive, accurate, and appropriate for dimensional assessment of biological data, 2) that during analysis of unfamiliar information a single global process is transiently evoked in the neuropil, and 3) after experience multiple spatially specific processes tonically map the sites of learning.     

Psychology ethics down under: a survey of student subject pools in Australia

A survey of the 37 psychology departments offering courses accredited by the Australian Psychological Society yielded a 92% response rate. Sixty-eight percent of departments employed students as research subjects, with larger departments being more likely to do so. Most of these departments drew their student subject pools from introductory courses. Student research participation was strictly voluntary in 57% of these departments, whereas 43% of the departments have failed to comply with normally accepted ethical standards. It is of great concern that institutional ethics committees apparently continue to condone, or fail to act against, unethical research practices. Although these committees have a duty of care to all subjects, the final responsibility for conducting research in an ethical manner lies with the individual researcher.     

Case vignette: premature surrender

Three commentaries are offered on the following case: George, age 57, is a previously healthy man who recently underwent surgery for removal of a low-grade malignant thymoma. At the time of admission to the hospital, George stressed to the staff that he had long ago signed a "living will," which he renewed immediately after he learned of his cancer diagnosis. At the time of surgery, the tumor was found to extend into his mediastinum; although it was removable, this required revision of part of the sternum and grafting of the vessels feeding the heart chambers. Because of the resultant tissue damage and neuronal hyperactivity, George experienced postoperative episodes of cardiac arrhythmia and bronchospasm. Unanimous medical opinion was that this situation was a temporary problem that would resolve itself as the tissues healed. Until that time, however, it will be difficult to wean him from ventilatory support. When his stay in the intensive care unit became prolonged, George and his family began to insist that his status be changed to "do not resuscitate" and reminded the staff about his longstanding living will. All of this is happening despite the fact that the patient and family seemingly comprehend that although the short-term interventions are invasive, there is a high probability of a successful outcome. George's cancer prognosis is excellent, and, although he may well have an episode of life-threatening arrhythmia, he is likely to respond to resuscitation interventions. Once the immediate postoperative period is over, his potential for a long and productive life with full capacities is excellent. Consider the following questions: (a) Should George's expressed wishes be respected, or should the staff take additional steps to help him survive the postoperative period, even if that means violating his stated wishes? and (b) What steps might the staff follow in sorting through this problem?     

Should a school honor a student's DNR order? A lawyer responds: a student's right to forgo CPR.

...Instead of and certainly before advising the school or S.A. to go into court, I would urge them to try to resolve the question where it arises -- in the classroom, not the courtroom. And I would ask school officials to try to place themselves in S.A.'s shoes, and to imagine how she feels about her situation; and to ask themselves how they will feel if they administer CPR against her and her parents' wishes. Is there no way that they can do more than nothing, but less than CPR? Which image would we prefer to attach to S.A.'s case, that of some lawyers giving a press conference on the courthouse steps or of a story about a school that made it possible for one of its students to spend her precious time with her friends, classmates, and teachers, as they learn together that death does not need to separate the living from the dying?     

Family interaction and child psychopathology: A comparison of two observation strategies

We examined two systems of assessing family interactions that are in common usage: a home based observation of free parent-child interaction and a clinic based observation of a structured mother-child problem solving discussion. Participants were 18 depressed, 27 conduct disordered and 16 comparison children and their mothers. Results indicated that: 1) these observations may yield very different data about child, and to a lesser extent, parent behavior, 2) parental affect in the clinic was related to their level of aversive behaviour in the home, 3) levels of both aversive and positive behavior for children and their mothers were correlated within each setting, 4) accuracy of diagnostic classifications made on the basis of the observational data were highest for comparison and conduct disordered children, but lowest for depressed children observed in the clinic, and 5) the inclusion of data on mothers' behavior increased classification accuracy for conduct disordered children only.