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BMJ No 7131 Volume 316 21 February 1998 Editor's Choice | This Week in BMJ | Press releases
BMJ No 7131 Volume 316 Papers - Abstracts Saturday 21 February 1998
Slater revisited: 6 year follow up study
of patients with
medically unexplained motor symptoms
Slater revisited: 6 year follow up study of patients with medically unexplained motor symptomsHelen L Crimlisk, Kailash Bhatia, Helen Cope, Anthony David, C David Marsden, Maria A Ron See Editorial by O'Brien, p 564 AbstractObjective: To investigate psychiatric and neurological morbidity, diagnostic stability, and indicators of prognosis in patients previously identified as having medically unexplained motor symptoms. Design: Follow up study. Setting: National Hospital for Neurology and Neurosurgery, London - a secondary and tertiary referral hospital for neurological disorders. Subjects: 73 patients with medically unexplained motor symptoms admitted consecutively in 1989-91. 35 (48%) patients had absence of motor function (for example, hemiplegia) and 38 (52%) had abnormal motor activity (for example, tremor, dystonia, or ataxia). Main outcome measures: Neurological clinical diagnosis at face to face reassessment by a neurologist and a psychiatric diagnosis after a standardised assessment interview - the schedule for affective disorders and schizophrenia - conducted by a psychiatrist. Results: Good follow up data were available for 64 subjects (88%). Only three subjects had new organic neurological disorders at follow up that fully or partly explained their previous symptoms. 44/59 (75%) subjects had had psychiatric disorders; in 33 (75%) patients, the psychiatric diagnosis coincided with their unexplained motor symptoms. 31/59 (45%) patients had a personality disorder. Three subjects had developed new psychiatric illnesses at follow up, but in only one did the diagnosis account for the previous motor symptoms. Resolution of physical symptoms was associated with short length of symptoms, comorbid psychiatric disorder, and a change in marital status during follow up. Conclusions: Unlike Slater's study of 1965, a low incidence of physical or psychiatric diagnoses which explained these patients' symptoms or disability was found. However, a high level of psychiatric comorbidity existed. Institute of Neurology, Institute of
Psychiatry, Correspondence to: Professor Ron email:M.RON@ion.ucl.ac.uk
Effect of temazepam on oxygen saturation and sleep quality at high altitude: randomised placebo controlled crossover trialGerald DubowitzAbstractObjective: To determine the effects of temazepam on the quality of sleep and on oxygen saturation during sleep in subjects at high altitude.Design: Randomised, blinded, crossover, placebo controlled trial. Setting: Base camp at Mount Everest (altitude 5300 m). Subjects: 11 members of British Mount Everest Medical Expedition recently arrived at base camp. Intervention: Participants were randomly allocated to receive either temazepam 10 mg or placebo on their first night at base camp and the other treatment on the second night. Main outcome measures: Quality of sleep (assessed subjectively), mean arterial oxygen saturation value, and changes in saturation values (as measure of periodic breathing) while participants taking temazepam or placebo. Results: All participants noted subjective improvements in sleep. Mean saturation value remained unchanged when temazepam was compared with placebo (74.65% versus 75.70%, P0.5437). There were fewer changes in oxygen saturation when participants took temazepam and when measured as decreases g4% below the mean value of saturation each hour (P0.0036, paired Student's t test (two tailed)). Conclusions: Participants taking temazepam at 5300 m showed no significant drop in mean oxygen saturation values during sleep. Both the number and severity of changes in saturation during sleep decreased and the quality of sleep improved. This may be a result of a reduction in the number of awakenings and might lead to greater respiratory stability and fewer episodes of periodic breathing. This has the effect of improving the quality of sleep and reducing the number of periods of desaturation during sleep.
British Mount Everest Medical
Expedition,
Correspondence to: Dr G Dubowitz email: gerald@iii.co.uk 20
Case-control study of risk of cerebral sinus thrombosis in oral contraceptive users who are carriers of hereditary prothrombotic conditionsS F T M de Bruijn, J Stam, M M W Koopman, J P Vandenbroucke for theAbstractObjective: To investigate whether users of oral contraceptives who are carriers of a hereditary prothrombotic condition (factor V Leiden mutation, protein C, S, or antithrombin deficiency) have an increased risk of cerebral sinus thrombosis.Design: Comparison of a prospective series of cases of cerebral sinus thrombosis with population data. Setting: Neurological teaching hospitals from different regions in the Netherlands (cases) and a representative sample of the non-institutionalised Dutch population (controls). Subjects: 40 women aged 18-54 years with cerebral sinus thrombosis (cases) and 2,248 women aged 18-49 years (controls). Main outcome measure: Current use of oral contraceptives at the time of the thrombosis (cases) or at the time of the questionnaire (controls). Prevalences of a hereditary prothrombotic condition in patients and in the population with odds ratios. Results: 34 of 40 (85%) women with cerebral sinus thrombosis used oral contraceptives, versus 1,007 of 2,248 (45%) of the control women; the age adjusted odds ratio was 13 (95% confidence interval 5 to 37). Seven of 36 patients (19%) had a prothrombotic deficiency, versus 7% expected in the population; this corresponds to a threefold to fourfold increase in risk. In women who used oral contraceptives and also carried a prothrombotic defect, the odds ratio for cerebral sinus thrombosis was about 30 relative to women who had neither risk factor. Conclusion: The use of oral contraceptives and being a carrier of a hereditary prothrombotic condition increase the risk of and interact in a multiplicative way in the development of cerebral sinus thrombosis.
Department of Neurology, Department of Clinical Epidemiology,
Design: Survey evaluating a task oriented, problem
solving course, designed by medical students in partnership with the
University of Leicester and the local community. The students, staff,
and participating agencies and patients all helped in the evaluation of
the first course. The students' performance on the course was also
individually assessed.
Setting: Inner city housing estate with Jarman index
64.1 in Leicester.
Subjects: All third year medical students at
Leicester University.
Main outcome measures: Results of the student
assignments and students' responses to a questionnaire. Results of
feedback questionnaires distributed to the patients and agency
representatives.
Results: In a two month period, 168 students
completed the first course. 163 students passed the criterion
referenced assignment, 50 of whom achieved an "excellent"
grade.
166 completed the questionnaire, with 159 wishing to see the course
continue in the present format and 149 saying that the course linked
theoretical teaching with the practical experiences gained in the
community.
Conclusions: The University of Leicester has a viable
mechanism for providing a community based, multiagency course for all
its medical students. Many of the principles applied in the development
and implementation of the course could be transferred to other medical
schools.
Division of
Medical Education,
Correspondence to:
Dr Lennox email: al36@Le.ac.uk
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