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Biomedical subjects

A A Maltbie

Publications and source records attributed to A A Maltbie.

At least 19 recordsLinked to original sources

Differentiation of depression from chronic pain with the dexamethasone suppression test and DSM-III.

The concept of chronic pain has become enmeshed with depression. In an attempt to unravel this complex relationship, the authors studied a uniform group of 42 patients with chronic pain, i.e., patients who had chronic low back pain with defined organic pathology, in relation to the dexamethasone suppression test (DST). The results were analyzed in relation to the presence or absence of major depression and cortisol suppression. Forty-one percent of the patients with major depression had abnormal cortisol responses to dexamethasone administration; all patients without major depression had normal responses. These results suggest that chronic pain patients differ from patients with major depression and a positive DST.

Adolescent↗

Electroconvulsive therapy in the presence of brain tumor. Case reports and an evaluation of risk.

The clinical basis for the long established contraindication of electroconvulsive therapy (ECT) in the presence of brain tumor is reviewed, as is the recent literature that has questioned the absolute nature of that contraindication. A need for a specific estimate of risk is noted. Seven retrospective case reports are added to the 28 cases reported in the literature. The clinical case report data are then pooled and evaluated by outcome. Results indicate a 74 per cent overall morbidity, including a 28 per cent 1-month mortality rate for patients with brain tumors who receive ECT. Twenty-one per cent of the patients had a positive behavioral response to ECT without complication.

Adult↗

Urinary tryptamine excretion in chronic schizophrenics with low platelet MAO activity.

Reduced platelet MAO activity has been previously reported as a biochemical marker for a subgroup of psychiatric patients, including some chronic schizophrenics. As tryptamine metabolism appears to be sensitive to alterations in MAO activity, urinary tryptamine excretion was measured in chronic schizophrenics with low platelet MAO activity, chronic schizophrenics with normal platelet MAO activity, and age-matched and sex-matched controls. The increased urinary tryptamine excretion observed in chronic schizophrenics with low platelet MAO activity may reflect a pathophysiologic mechanism associated with low MAO activity.

Adult↗

Medical management of chronic cancer pain.

Management of the chronic pain of cancer is a common and difficult problem. In addition to a medical examination of the patient, it is necessary to perform a psychological assessment of his premorbid personality, current mental status, and coping mechanisms to devise an individualized approach to his pain. The mainstay of cancer pain control are the narcotics, which differ primarily in potency and duration of action. Nonnarcotic analgesics are equianalgesic with the less potent narcotics. Antipsychotic drugs are useful as tranquilizers, antiemetics, and analgesic potentiators. Antidepressants and hypnotics permit the patient a more normal life-style. Stimulants such as cocaine and amphetamines both potentiate narcotic analgesia and reduce narcotic-induced somnolence and respiratory depression. Tetrahydrocannabinol offers no advantage over traditional analgesics. With care and patience, the physician can render practically any cancer patient pain-free.

Analgesics, Opioid↗

A clinical note on hysterical psychosis.

The authors review the concept of hysterical psychosis and its reported psychodynamics. They suggest a psychodynamic issue that apparently has not been previously reported, namely, emotions engendered by an overt sexual advance or rage and disappointment over a lack of a sexual advance. This finding can be most helpful in distinguishing a case of hysterical psychosis from an acute schizophrenic episode.

Acute Disease↗

Analgesia and haloperidol: a hypothesis.

We have previously reported 10 patient histories involving various intractable pain syndromes where the administration of Haloperidol either eliminated the need for narcotic analgesics or resulted in a significant reduction in narcotic dosage. We are presently undertaking a controlled double-blind evaluation of Haloperidol as an adjunctive treatment for intractable cancer pain. Based upon the reported clinical observations, these findings are discussed from the following aspects: 1. The isomeric similarity of Haloperidol to Meperidine. 2. Dose response between Haloperidol and analgesic effect. 3. The clinical literature regarding the use of Haloperidol for the effective withdrawal or maintenance of narcotic addicts. 4. The analgesic property as it relates to the opiate receptor.

Analgesics↗

Depression simulating organic brain disease.

The authors report four cases of depression manifesting as organic brain syndrome in adult nongeriatric patients. The correct diagnoses in three cases were made by a psychiatrist's or resident's empathic response to the patient, and in the fourth by the patient's history of depression. The authors state that only by maintaining a high degree of suspicion and trusting one's empathic response to the patient will unusual presentation of depression be recognized.

Adult↗

Familial biochemical and clinical correlates of alcoholics with low platelet monoamine oxidase activity.

This study substantiates previous reports that low platelet MAO activity is associated with alcoholism. The results also indicate that low platelet MAO activity in alcoholic probands is associated with a higher prevalence of psychiatric hospitalization in first-degree family members as well as alcoholism and suicide attempts among alcoholics. Psychiatrically ill family members of the alcoholic probands with low platelet MAO activity also demonstrate low enzyme activity whereas the well family members have normal enzyme activity.

Adult↗