Surf therapy for improving child and adolescent mental health: A pilot randomised control trial

The aim of this pilot randomised control trial (RCT) was to test, 1) feasibility and acceptability of a surf therapy program to improve symptoms of mental ill-health among children and adolescents, and 2) the design and procedures of an evaluative study. This pilot RCT compared a 6-week mentor-supported surf therapy program with a wait list control group, in Australian children and adolescents aged 8-18yrs (M age = 11.28, SD = 2.34; 15 females), who were help seeking for issues relating to their mental health. Exclusion criteria included if an individual was actively suicidal or experiencing a psychotic episode or being unavailable for program dates. The primary outcome was the feasibility and acceptability of the intervention and study design assessed via 11 pre-defined criteria. A secondary outcome was to investigate the effectiveness signal of the intervention on child indicators of depression and anxiety, assessed via the Revised Children's Anxiety and Depression Scale-Short Form and the Strengths and Difficulties Questionnaire. Random allocation was computer generated and while it was not possible to blind participants, researchers collecting assessments were blinded to group allocation. Thirty-six youth were randomised (intervention = 18; wait list controls = 18), representing an 84% participation rate among eligible youth. Of the 11 a priori feasibility and acceptability criteria, 4 of 5 relating to the intervention, and 4 of 6 addressing the study design were fully met, with the unmet factors guiding program revision. At the completion of the intervention, children and adolescents receiving the intervention reported reductions in symptoms of depression (ES = 0.57), anxiety (ES = 0.43), emotional problems, (ES = 0.79), peer problems (ES = 0.56), hyperactivity/inattention (ES = 0.28), and overall difficulties (ES = 0.64). These reductions were not sustained 6-weeks after completion of the intervention. Surf therapy is an acceptable and feasible intervention for addressing symptoms of mental ill-health among children and adolescents. Preliminary evidence suggests that surf therapy improves symptoms of mental ill-health in the short-term but that these improvements were not sustained after the intervention is ceased.

Study of molecular structure, chemical reactivity and H-bonding interactions in the cocrystal of nitrofurantoin with urea

The cocrystal of nitrofurantoin with urea (C₈H₆N₄O₅)·(CH₄N₂O), a non-ionic supramolecular complex, has been studied.

An electroencephalographic investigation of short-term effects of three hypothalamic hormones (TRH, LH/FSH-RH, GH-RIH) in normal subjects

Three hypothalamic regulatory hormones, thyrotrophin-releasing hormone (TRH), luteinizing hormone/follicle-stimulating hormone-releasing hormone (LH/FSH-RH) and growth hormone-release inhibiting hormone (GH-RIH) given intravenously had no effect on the electroencephalographic response known as the contingent negative variation (CNV) in normal subjects. TRH was given as a 10 ml infusion of 600 microg over 8 min to six subjects. This produced subjective sensations and a rise in heart rate but no significant alteration of CNV magnitude. LH/FSH-RH was given in a dose of 200 microg in 10 ml over 2 min to six subjects. This had no effect on CNV magnitude or heart rate and produced no subjective effects. GH-RIH was given as a 10 ml infusion of 250 microg over 10 min to six subjects. Again there was no alteration in the magnitude of the CNV; the heart rate was slowed.

A comparison of some physiological and psychological effects of propranolol and diazepam in normal subjects

Some central and peripheral effects of orally administered propranolol (60 mg), diazepam (5 mg) and placebo were compared in normal subjects. The central effects measured were changes in magnitude of the contingent negative variation (CNV) and subjective anxiety ratings; the peripheral effects were changes in heart rate, blood pressure, galvanic skin response and hand steadiness. After diazepam there was a decrease in CNV magnitude and in the level of subjective anxiety; there was a slight fall in blood pressure but little change in heart rate. After propranolol, on the other hand, there was no significant change in CNV magnitude or anxiety rating, but a significant fall in heart rate and systolic blood pressure. It is concluded that, at the dosage used, propranolol, unlike diazepam, does not affect the central mechanisms determining CNV magnitude or subjective anxiety. The relationship of this finding to the use of beta-adrenergic receptor blockers in clinical anxiety states is discussed.

Disparity in the risk stratification of major surgery

This case report illustrates the dilemma of risk prediction. In the objective documentation of peri-operative risk, cardiopulmonary testing offers a holistic assessment. At present, availability is limited and, as such, it is important to be mindful of the limitations of other more traditional forms of risk assessment.

Obstacles to effective treatment of depression: a general practice perspective

BACKGROUND

The Clinical Standards Advisory Group (CSAG) was asked by UK health ministers to advise on the standards of clinical care attainable for people with depression. The GP survey reported here is one part of a multicomponent UK-wide study of services for depression that also included visits to a sample of services and structured patient telephone interviews.

OBJECTIVES

The aim of this study was to survey GPs' perceptions of the availability and quality of primary and community-based services for people with depression, and to seek their views on barriers to the provision of good clinical services.

METHODS

A structured postal questionnaire was sent to all GPs (3530) in the 11 geographical areas visited during the CSAG study.

RESULTS

A total of 1703 (48%) GPs returned the questionnaire. The main obstacles to providing a good service for people with depression included not having enough time, a lack of services to refer to and difficulty in accessing services. More than half of the respondents (58%) were aware of guidelines for the management of depression, and 62% had attended a teaching session on depression within the last 3 years. Factors that influenced GPs to refer people with depression to other services were risk to the patient, a clear need for specialist treatment and the need for assessment. Overall, GPs appeared to be satisfied with the quality of specialist services.

CONCLUSIONS

GPs appeared to view obstacles to providing effective treatment of depression as being more allied to external issues, in particular service provision, rather than internal factors such as their own knowledge and skills. The study revealed continuing concerns over excessive workload, and longstanding difficulties with the interface between primary and secondary mental health services.

Lithium toxicity

We report a case of severe lithium toxicity precipitated by a thiazide diuretic and compounded by an angiotensin converting enzyme inhibitor. There was severe vasodilatation refractory to noradrenaline.

Psychological problems following minor head injury: a prospective study

Fifty people admitted to hospital with a predominantly minor head injury were interviewed six months and three years later. As a group, they showed evidence of post-traumatic stress disorder consistent with the DSM-III-R (American Psychiatric Association, 1987) definition, and psychological distress as measured by the Impact of Event scale and the General Health Questionnaire. In addition, changes in self-concept were measured and a prominent theme emerged of the discontinuity in the participants' sense of self following the head injury. These changes showed a significant relationship with psychological symptoms. Occupational and social functioning of the participants is also reported. It is suggested that disturbance and change following minor head injury is common and can be chronic.

Observations on the Object Learning Test of the Kendrick Battery for the Detection of Dementia

This paper examines some shortcomings in the design and validation of the Object Learning Test of the Kendrick Battery. Certain issues which are important to ensure standardized administration of the test have not been considered, and the scoring procedures penalize some correct responses. Line drawings on the cards are occasionally ambiguous, and some of the repeat drawings are reproduced with unnecessary alterations. The parallel forms of the test are not matched for word frequency of the names of the objects. Questions are raised concerning the cut-off point for ascribing dementia and the statements of confidence in test diagnosis.

Biphasic dose-related responses of the CNV (contingent negative variation) to I.V. nicotine in man

1 The effects of intravenous injections of nicotine bitartrate, given as intermittent `shots', on the magnitude of the contingent negative variation (CNV) were studied in twelve male volunteers.

2 In one series of experiments in five subjects, a fixed dose of nicotine was used. In three of these subjects nicotine 500 μg or 750 μg produced a reproducible increase in magnitude of the CNV. In two subjects nictone 750 μg produced a reproducible decrease in magnitude of the CNV. The direction and magnitude of the CNV changes could be reproduced by cigarette smoking.

3 In another series of experiments in eight subjects, dose-response relationships for the effect of nicotine on the CNV were measured using a range of doses from 12.5 to 800 μg. Individual and mean dose-response curves were found to be biphasic so that whilst smaller doses produced an increase of CNV magnitude (stimulant effect), larger doses produced a decrease of the CNV (depressant effect).

4 The results are discussed in relation to the possible mechanism of action on the brain of nicotine as obtained by inhaling cigarette smokers.

Echocardiographic assessment of cardiac chamber size and left ventricular function in aerobically trained athletes

We compared the echocardiographic assessment of left ventricular function in 20 aerobically trained male athletes (VO2 max 61 ml/kg/min) with 20 control subjects of similar age and size (VO2 max 37 ml/kg/min). On average, the left ventricle was larger in athletes and the extent of myocardial contraction (fractional shortening) was reduced. In nine athletes, fractional shortening was less than our laboratory lower limit of normal (26%) and in four athletes the left ventricle was enlarged and fractional shortening was reduced. However, the peak rate of circumferential shortening was not reduced in athletes. We concluded that athletes have normal myocardial contractility but some have a reduced extent of myocardial contraction which could be mistaken for the effects of myocardial disease.

Cognitive functions in manic-depressives: effects of lithium and physostigmine

Cognitive functions were investigated in seven manic depressive patients while on lithium, after two weeks off lithium, and after a subcutaneous injection of physostigmine while on lithium. Test performance was unaffected by lithium, but after physostigmine the I.Q. score of a shortened version of the WAIS was significantly increased.

A comparison of some physiological and psychological effects of Motival (fluphenazine and nortriptyline) and diazepam in normal subjects

1 The effects in normal subjects of a single oral dose of Motival (one tablet, containing fluphenazine 0.5 mg and nortriptyline 10 mg) on the contingent negative variation (CNV), reaction time, heart rate, blood pressure and self-rating scales for alertness, anxiety, tension, detachment and depression were compared with those of diazepam (5 mg and 7.5 mg) and placebo or propranolol (60 mg). 2 After diazepam (5 mg: twelve subjects and 7.5 mg: seven subjects) there was a significant decrease in CNV magnitude while after Motival (twelve subjects) there was no significant alteration in CNV magnitude compared to placebo. 3 After diazepam (7.5 mg: seven subjects) there was also a fall in subjective ratings for alertness and tension; this fall was significantly greater than the changes after Motival which did not reduce subjective ratings for alterness or tension below "average" levels. Anxiety ratings did not differ significantly between the two drugs. Changes after propranolol were intermediate in all scales. 4 It is concluded that under these conditions diazepam caused central nervous system depression while Motival did not.