A survey of the pharmacological and psychological treatment of panic disorder and agoraphobia (PDA) was conducted among 103 physicians, psychologists and psychotherapists. It revealed that the treatments for PDA preferred by the majority of the respondents are inconsistent with the recommendations given in the international literature. Non-psychiatric physicians most frequently proposed herbal preparations as a possible treatment (46% of non-psychiatric physicians), followed by homoeopathic formulations (32%). Tricyclic antidepressants which are recommended as first-line treatment in panic disorder by the literature are preferred by 74% of the psychiatrists, but only by 24% of the non-psychiatric physicians. Benzodiazepines are prescribed by twice as many psychiatrists (45%) as non-psychiatric physicians (22%). Beta blockers and neuroleptics which are not recommended as first-line treatment in panic disorder are used quite often (psychiatrists: 15%; non-psychiatric physicians: 26%). Selective serotonin reuptake inhibitors are prescribed by 24% of the psychiatrists, but by only 3% of the non-psychiatric physicians. Among psychological therapies, psychoanalysis was proposed as first-line treatment by 44% of all professionals applying psychological therapies, while cognitive/behaviour therapy was preferred by only 28%, though proof of efficacy exists only for cognitive/behaviour therapy. In general, psychologists prefer behaviourally-orientated therapy, while physicians mostly propose psychodynamic therapy. One reason for the fact that the results of controlled studies have little influence on professionals treating PDA patients might be that 40% of the respondents do not accept the new classification of the anxiety disorders as introduced in 1980 by the DSM-III.

Open trials with tricyclics, classical monoamine oxidase inhibitors (MAOIs) or lithium in dysthymia yielded a response rate in 45% of subjects. A long-term treatment of dysthymia with 276 patients treated during 4 years with either moclobemide, tranylcypromine or a combination of amitryptiline plus chlordiazepoxide is described. After discontinuation there was a relapse rate of 89.1%. The controlled studies with tricyclics, MAOIs, reversible inhibitors of monoamine oxidase (RIMAs), specific serotonin reuptake inhibitor (SSRIs) or benzamides showed that drugs well-tolerated work better in dysthymia, due to the fact that the treatment must be long-term. Sertraline was studied vs placebo or imipramine in primary dysthymia. Moclobemide, imipramine and placebo were also studied in 315 patients. Mean doses were 650 mg/d of moclobemide and 203.2 mg/d of imipramine. Moclobemide and sertraline were both efficacious and well tolerated. In a long term treatment the clinician should assess the risk-benefit ratio. Dysthymic patients are very sensitive to unwanted effects and compliance is a serious issue.

This review on Parkinson's disease (PD) considers pharmacological and surgical management and important non-motor symptoms (NMS) such as depression, dementia and sleep disorder. In the absence of a proven neuroprotective drug, therapy remains symptomatic and may be initiated with levodopa or a dopamine agonist or a monoamine oxidase inhibitor. Treatment should be tailored to the individual patient, with patient preference, extent of functional impairment and co-morbidity more important than age per se. As disease progresses, therapy usually becomes more complex and apomorphine, duodopa and surgical intervention may be useful.

NMS may be present at any stage of illness but become more common in severity and frequency with advanced disease, when neuropsychiatric features such as dementia and psychosis dominate the clinical picture. NMS are often unrecognized and undeclared by patients and carers in clinic. Novel agents for treating non-motor features, which are often poorly responsive to dopaminergic therapy, are urgently required.

Objectives: The aim of this study was to explore whether Bayesian reasoning can be applied to therapeutic questions in a way that is similar to its application in diagnostics.

Methods: A clinically relevant, therapeutic question was formulated in accordance with Bayesian reasoning for the clinical management of patients with newly diagnosed rheumatoid arthritis (RA). Prior probability estimates of response to drug treatment (methotrexate, MTX) were obtained from the literature. As a marker of treatment response, changes in the Health Assessment Questionnaire (HAQ) scores were assessed after three months of treatment. Likelihood ratios for this marker were calculated on the basis of data from a clinical registry, using changes in the Disease Activity Score (DAS) as gold standard. Using Bayes’ theorem, prior probability and likelihood ratios were combined to estimate posterior probabilities of treatment response in individual patients.

Results: On the basis of the literature, the prior probability of response of RA patients to MTX was estimated 45 percent. At 3 months follow-up, this probability increased to 80 percent or decreased to 23 percent, depending on the changes that were observed in Health Assessment Questionnaire scores.

Conclusions: Bayesian reasoning can be applied to therapeutic issues in a way that is conceptually fully compatible with its use in diagnostics. As such, it can be used to bridge the gap between aggregate data and individual patient management.

Physicians (N = 803) were contacted via postal survey and given two sets of efficacy measures for drug treatments in Alzheimer's disease: (a) the time that patients spend in a mild or moderate state of disease; (b) levels of modification to disease progression in the areas of cognition, behaviour, and mood, and ability to perform basic activities of daily living. Physicians reported that they would prescribe a hypothetical, new Alzheimer's disease medication if it would allow patients to remain in their current disease state for 15 (mild) or 11 (moderate) additional months. Most physicians required a permanent halt to, or some reversal of, disease progression as a prerequisite for prescribing; a few required substantial reversal. More stringent efficacy requirements were negatively associated with physicians' current prescribing of cholinesterase inhibitors to persons with Alzheimer's disease, although the effects were either small (odds ratio = 0.99) or not statistically significant at the 5 per cent level. The results suggest that physicians with stringent efficacy requirements for clinically relevant efficacy measures are less likely to prescribe cholinesterase inhibitors.

Irreversible pathological lesions were noted in the organs of mice infected with 1 of 3 rodent malaria species: Plasmodium chabaudi chabaudi, P. vinckei petteri and P. yoelii nigeriensis at different times during the course of the primary parasitaemia and long after microscopical clearance of the parasites. Moreover, similar lesions were also obtained when parasite levels were kept below 1%by subcurative drug treatment. The frequency and severity of the lesions correlated with the duration of the infection. Accumulation of tissue damage during chronic low-grade malaria infections has implications for the design of control measures.

We describe two fetuses presenting with hydrops and tachycardia who were treated by prolonged dosage with procainamide. Initial therapy with digoxin in both had been unsuccessful in controlling the rapid heart rate. The first child was delivered after five weeks of transplacental therapy, and demonstrated Wolff-Parkinson-White syndrome on the second day which was controlled with flecainide. The second fetus required three and a half weeks of intrauterine treatment. Wolff-Parkinson-White syndrome became manifest four days after premature labor at 33 weeks gestation. No tachycardia occurred postnatally and the infant has been well during follow-up. The implications of treatment are discussed.

In the United Kingdom (UK) and elsewhere, little is known about problematic drug use among older people (defined here as aged 50–74 years), either because few older drug users exist or because they represent a ‘hidden’ population. In this paper, we show that the average age of drug users in contact with treatment services and agency-based syringe exchange programmes (SEPs) in the counties of Cheshire and Merseyside in northwest England is rising. Between 1998 and 2004–05, the number of older male drug users in treatment increased from 80 to 310, and the number of older females rose from 46 to 117. Consequently, the median age rose from 30.8 years in 1998 to 34.9 years in 2004–05. Similarly, between 1992 and 2004, the number of older injectors accessing SEPs increased from three to 65 men and from one to nine women. The median age of SEP attenders was 27.0 years in 1992 and 34.9 years in 2004. Drug use amongst older people is associated with poor physical and psychological health and longer hospital stays. The future cost of the ageing of drug users may be considerable. Detailed research is needed to identify the characteristics and health needs of this vulnerable population.

This article demonstrates how cultural ideologies of language, and the semiotic processes that mobilize them, manifest in contemporary American drug treatment. Drawing from an ethnographic study of an outpatient program in the Midwestern United States, it focuses on therapists' claims about what constitutes “healthy language.” It is argued that these claims both stem from and actively reproduce an “ideology of inner reference,” which presumes that “healthy” language refers to preexisting phenomena, and that the phenomena to which it refers are internal to speakers. By formally discouraging talk that could point outside the parameters of the individual psyche, the treatment program effectively insulates itself from clients' critiques and challenges. A broad attempt is made to elucidate the connection between a language ideology that enjoys wide cultural circulation as well as significant currency in contemporary clinical practice, and a particular political effect called “institutional insulation.”My thanks to Barbara Johnstone and two anonymous reviewers for their insightful, critical comments on an earlier version of this article. I am especially grateful to James Wilce for his keen advice on how to refine central elements of the argument and his guidance toward relevant, fruitful literature. The following people contributed significantly to the essay's development (though its remaining flaws are very much my own): Giorgio Bertellini, Webb Keane, Daniel Listoe, Beth Reed, Douglas Rogers, Michael Sosin, and Sarah Womack. I'd also like to thank the University of Chicago Anthropology Department, Center for Gender Studies, Committee on Human Development, and School of Social Service Administration for opportunities to present (and rethink) earlier versions. The research reported here was conducted with the support of a training fellowship from the National Institute of Mental Health and various grants from the Department of Anthropology, the Institute for Research on Women and Gender, the Program in Women's Studies, Rackham Graduate School, and the School of Social Work, all at the University of Michigan. This essay is for “Lila.”

The aim of this paper was to test the long-term contribution of cognitive-behavioural therapy to the treatment of mixed anxiety-depression disorder. Fifty-seven patients, selected according to DSM-IV diagnostic criteria, were assigned to: 1) cognitive-behavioural therapy; 2) combined therapy (drug and cognitive-behavioural therapy); or 3) a standard drug therapy control group. A multigroup experimental design with repeated measures of assessment (pretreatment, posttreatment, and 3-, 6- and 12 month follow-ups) was used. Most patients who were treated (71%) in experimental groups showed significant improvement at the 12-month follow-up, but there were no differences between the two therapeutic modes. No improvement was shown by the control-group participants at the 6-month follow-up. The results of the present trial do not support the beneficial effects of drug therapy by itself for this disorder. Finally, several topics that may contribute to future research in this field are discussed.

The potential for development of 2 to 1 atrioventricular conduction in children with prolongation of the QT interval has been previously reported secondary to electrolytic disturbances. We report here a child who developed 2 to 1 atrioventricular conduction with prolongation of the QT interval following treatment with amiodarone for refractory supraventricular tachycardia. We highlight the importance of electrocardiographic monitoring to assess for those at risk of amiodarone toxicity, which may be manifested by prolongation of the QT interval and the simultaneous loss of atrioventricular conduction, and of equal importance the need for prompt conversion to an alternative anti-arrhythmic agent.

Our objective was to assess the efficacy of pharmacological treatment in reducing the incidence of permanent junctional reciprocating tachycardia in young children, or to bring the mean heart rate over 24 h to a normal level.

We included 21 children with a median age of 0.05 year seen with permanent junctional reciprocating tachycardia over the period 1990 through 2001. Of these children, two had abnormal left ventricular function. Follow-up visits were made at least every 6 months. We registered the presence of the tachycardia over 24 h, the mean heart rate over 24 h, and cardiac function. Treatment was started with propafenone alone, or in combination with digoxin as the first choice. Treatment was effective in 14 cases (67%), with either complete disappearance of the tachycardia after discontinuation of medication, or continuation in sinus rhythm with medication; partially effective in 4 cases (20%) when the mean heart rate over 24 h on the last Holter recording was less than 1 standard deviation above the normal for age; but was not effective in the remaining 3 cases (14%). In 3 patients treated with propafenone, or 13 given propafenone and digoxin, treatment was effective in 12 (75%), partially effective in 2 (13%), and ineffective in the other 2 (13%).

All 21 children had a normal left ventricular function at the end of follow-up. The median duration of follow-up was 2.4 years. Permanent junctional reciprocating tachycardia had disappeared spontaneously in one-third of the children, 5 being less than 1 year old. Adverse effects, seen in 5 cases, were mild or asymptomatic. No signs of proarrhythmia were registered.

Pharmacological treatment, either with propafenone alone, or in combination with digoxin, is safe and effective in young children with permanent junctional reciprocating tachycardia. The mean heart rate is normalized, and cardiac function is restored and preserved. Radiofrequency ablation may be delayed to a safer age, with the arrhythmia disappearing spontaneously in one-third.

New data are emerging on the use of palivizumab as prophylaxis against infection with the respiratory syncytial virus in infants with congenital cardiac disease. Following a 4-year multicentre randomised trial, it was shown that prophylactic injections with palivizumab were effective and safe for such children. Prophylaxis consists of 5, monthly, intramuscular injections of palivizumab, at a dose of 15 mg/kg, given during the season for infection with the respiratory syncytial virus. Timing is at the discretion of the physician, depending on the onset of the season locally. It is suggested that, in the United Kingdom, this should be commenced in mid-September. To help clinicians to identify appropriate candidates for palivizumab, a working group of the British Paediatric Cardiac Association has developed recommendations.

Infants, namely those under 1 year old, with congenital cardiac disease likely to benefit from prophylaxis include those with haemodynamically significant lesions, particularly increased pulmonary blood flow with or without cyanosis; pulmonary venous congestion, pulmonary hypertension or long-term pulmonary complications, residual haemodynamic abnormalities following medical or surgical intervention (patients who have undergone cardiopulmonary bypass should receive an injection as soon as they are medically stable), cardiomyopathy requiring treatment, and congenital cardiac disease likely to need hospital admission for medical or surgical intervention during the season of infection with the virus. Prophylaxis with palivizumab may also be indicated, at the discretion of the physician, in some children with complex cardiac disease over the age of 1 year. Children less likely to benefit from prophylaxis are those with haemodynamically insignificant disease, or those with lesions adequately corrected by medical or surgical intervention.

The use of a standardised protocol for the pharmacological (using Selective Serotonin Re-uptake Inhibitors–SSRIs) and psychological treatment of 10 consecutive adolescent patients with Obsessional Compulsive Disorder is reported. The psychological treatment consisted of exposure to the feared stimulus and cognitive behavioural treatment of anxiety associated with this procedure. The results suggest that there are benefits from both pharmacological and psychological treatments. However, both treatments were difficult to implement. For the SSRIs, some patients reported disinhibition of mood swings and behaviour. For those patients who showed benefits from the pharmacological treatments, there appeared to be a decrease in willingness to attempt psychological methods. The psychological methods require considerable time, which may not be available in clinics, and substantial effort by the patients.