Gender-divergent aetiological factors in obsessive-compulsive disorder.

Among 307 adults with OCD, early onset (age 5-15 years) was more common in men and later onset (age 26-35 years) in women. Early onset was associated with more checking, and late onset with more washing. More women than men had a history of treated depression; 12% of the women but none of the men had a history of anorexia.

Sucralfate--safety and side effects.

The safety of sucralfate in terms of aluminium absorption, excretion, tissue accumulation, and toxicity is discussed, with special reference to the small amount of aluminium absorbed, its ready excretion by the normal kidney, and the hazard of toxicity in patients with advanced renal failure. The various manifestations of aluminium toxicity are described, and the notion that Alzheimer's disease should be included in this category is refuted. The clinical relevance of possible intraluminal binding and drug-drug interactions in patients receiving sucralfate therapy is also considered.

Audiotape therapy for persistent auditory hallucinations.

We report a case of a man with recurrent depression and persistent second-person auditory hallucinations telling him to kill himself. Using an audiotape cassette and headphones the duration of the hallucinations decreased significantly. Helpfulness of the audiotape continued at 15 months follow-up.

Clonidine versus long- and short-term methadone-aided withdrawal from opiates. An uncontrolled comparison.

Twelve heroin addicts and one methadone addicts began withdrawal from street opiates, under clonidine cover, in a general psychiatric ward. Ten (80%) of them completed it within 6 days. Clonidine doses used were lower than in similar studies and all patients were alert and mobile throughout withdrawal.

Duodenal ulcer healing and acid secretory responses to modified sham feeding and pentagastrin stimulation.

The effect of duodenal ulcer healing on the acid secretory responses to modified sham feeding and maximal pentagastrin stimulation has been studied in 17 patients treated successfully with ranitidine (n = 9) and sucralfate (n = 8). Parietal cell sensitivity was calculated as the ratio of the modified sham feeding response to the peak pentagastrin response, expressed as a percentage. Ulcer healing after sucralfate therapy resulted in significant falls in modified sham feeding stimulated acid output (P less than 0.

[Behavior psychotherapy in obsessive-compulsive disorders].

Although their problem is often as disabling as in chronic schizophrenia, most cases of obsessive-compulsive disorder have become eminently treatable by the behavioural approach of live exposure with response prevention. Treatment takes from 1 to 6 months depending on the severity of the problem, and may need an overall mean therapist time of +/- 8 hours time per patient. Most psychiatrists can learn to apply the treatment quite quickly, and most patients can be treated on an outpatient basis.

Common variable hypogammaglobulinemia. A case report.

We describe a patient with severe common variable hypogammaglobulinemia (CVH) whose clinical course was dominated by resistant giardiasis requiring prolonged hospitalization. The giardiasis was eventually controlled by initial metronidazole and subsequent mepacrine therapy, but side effects necessitated the withdrawal of both of these drugs. Replacement immunoglobulin treatment failed to restore normal serum immunoglobulin levels, but despite this, they appeared to be of value in reducing the liability to recurrent giardiasis.

Obsessive-compulsive disorder: case study and discussion of treatment.

A patient's own account of her obsessive-compulsive disorder is presented. She describes her distressing experiences, the impact of the disturbance on her and her family's life and her subsequent improvement using the technique of exposure and response prevention. The treatments available are discussed and the benefits of self-directed behavioural psychotherapy are reviewed.

Simple closure of perforated duodenal ulcer: a prospective evaluation of a conservative management policy.

One hundred and thirteen consecutive patients admitted with a perforated duodenal ulcer over a 5-year period (1978-82) and treated by simple closure have been followed prospectively over a median period of 43 months. Patients were divided into two categories according to their previous history of dyspepsia; group 1 (66 patients) with a chronic history of more than 3 months and group 2 (47 patients) where there was no history of dyspepsia or a history of less than 3 months duration. The follow-up periods were similar (group 1, 44 months; group 2, 43 months).

Learning and unlearning fear: a clinical and evolutionary perspective.

Many fears, phobias and rituals seem to arise from prepared phylogenetic mechanisms which favor old over new evolutionary dangers and affect the rules of aversive learning which govern the acquisition of fear. Recent developments in several forms of aversive learning (sensitization, conditioning, extinction, observational learning) can improve them as paradigms of the acquisition, spread and maintenance of normal and clinical fears. The most reliable treatment for phobias and rituals is exposure, whose effects closely parallel the habituation of normal defensive responses and the extinction of conditioned fear and avoidance in animals.

A controlled study of fluvoxamine and exposure in obsessive-compulsive disorder.

DSM-3 obsessive-compulsive out-patients were randomly assigned to fluvoxamine with antiexposure (F), fluvoxamine with exposure (Fe), or placebo with exposure (Pe) for 24 weeks. Of 65 patients offered treatment 60 entered the trial, 50 reached week 8, 44 completed treatment to week 24, and 37 reached follow up to week 48. On average the patient had depressed mood (mean Hamilton depression rating scale = 19).

Onset of panic disorder with agoraphobia. Toward an integrated model.

Of 57 patients with panic disorder with agoraphobia, more had their first panic in late spring and summer than in fall and winter, and in warm weather than in cold weather. In the month before the first panic 52% of the patients had prodromal depression or anxiety. Agoraphobic avoidance preceded the first panic in 23%, began within days after the first panic in 32% (without prodromal anxiety or depression in only 20%), and after more than one panic (1 week to 11 years later) in 41%.

The spectrum and natural history of common bile duct stenosis in chronic alcohol-induced pancreatitis.

Sixty patients with chronic alcohol-induced pancreatitis with endoscopic retrograde cholangiopancreatography evidence of common bile duct stenosis were studied to determine the clinical spectrum and natural history of this complication, as well as the indications for biliary bypass. In 17% of patients, common bile duct stenosis (CBDS) was an incidental finding at ERCP, while in the remaining cases pain and jaundice were the predominant symptoms in 35% and 48%, respectively. Biliary drainage was performed in 38% of patients for persistent or recurrent jaundice, cholangitis, and while undergoing pancreatic duct or cyst drainage procedures for pain.

Fear talk versus voluntary hyperventilation in agoraphobics and normals: a controlled study.

Twenty-three drug-free patients with agoraphobia and panic disorder (DSM-III criteria) had, at rest, lower mean end-tidal PCO2 (32 v. 36 mmHg) and higher mean heart rate (92 v. 83 bpm) than did 18 controls.

Acid-secretory response and parietal cell sensitivity in patients with duodenal ulcer before and after treatment with sucralfate or ranitidine.

Patients with endoscopically proved duodenal ulcer were randomly assigned to treatment with either ranitidine 300 mg at bedtime or sucralfate 2 g twice daily for six weeks. Acid-secretory studies were performed before commencement and 60 to 84 hours after cessation of treatment and endoscopic healing was confirmed. Patients were randomly assigned to receive a constant infusion of secretory stimulant: either pentagastrin 0.

A maintenance regimen of sucralfate 2 g at night for reduced relapse rate in duodenal ulcer disease. A one-year follow-up study.

One hundred seventeen patients with recently healed duodenal ulcers were entered into a one-year maintenance study. Patients were randomly assigned to treatment with sucralfate 2 g at night, cimetidine 400 mg, or placebo. The sucralfate versus placebo leg of the study was double-blind, whereas the cimetidine leg was single-blind.