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Biomedical subjects

A Rifkin

Publications and source records attributed to A Rifkin.

At least 19 recordsLinked to original sources
PubMed1992

Depression in physically ill patients. Don't dismiss it as 'understandable'.

Depression in the physically ill is common and may even be caused by certain physical disorders (eg, hypothyroidism, pancreatic cancer) or the use of some types of drugs. It should not be dismissed because it is "understandable" in particular situations, but rather, it should be differentiated from overlapping symptoms of the physical disorder and treated. The effect of psychosocial factors should be carefully considered.

Antidepressive Agents↗
PubMed1992

Adjunctive imipramine for dysphoric schizophrenic patients with past histories of cannabis abuse.

1. Twenty-one schizophrenic or schizoaffective patients with histories of cannabis abuse and operationally-defined syndromes of post-psychotic depression completed a double-blind trial of adjunctive imipramine added to their on-going medication regimen of fluphenazine decanoate and benztropine. 2. The imipramine-treated patients had superior global outcome. 3. Subscales suggested that specific improvement occurred in imipramine-treated patients in the domain of depression-like features. 4. Psychotic symptomatology was not found to be exacerbated by the imipramine.

Adolescent↗
PubMed1992

Discontinuation of alprazolam after long-term treatment of panic-related disorders.

Discontinuation of alprazolam after long-term treatment of 142 patients with panic-related disorders was examined in five study sites using a telephone interview. The majority (67%) of patients interviewed discontinued alprazolam for a period of at least 3 days after a gradual dosage reduction schedule over a 4-week period at the end of the long-term treatment study. A marked difference among the study sites in percentages of patients discontinuing therapy with alprazolam suggests that physician intervention played an important role in determining the ability of patients successfully to discontinue use of alprazolam: 90% and 95% of patients ceased therapy at two sites whereas only 21%, 38%, and 66% of patients discontinued therapy at the other three sites. The mean daily dosage for patients who continued using alprazolam decreased from 5.1 mg/day at the end of the long-term segment to 2.7 mg/day at the time of the poststudy interview. This decline indicates a lack of tolerance to the therapeutic effectiveness of alprazolam over an extended period of time.

Adult↗
PubMed1991

Dosage of haloperidol for schizophrenia.

Eighty-seven newly admitted inpatients with schizophrenia were randomized to receive 10, 30, or 80 mg/d of oral haloperidol. They were treated under double-blind conditions for 6 weeks, less if their acute symptoms remitted sooner. Survival analysis showed no differences among the three treatments. Side effects were minimal in all three treatment groups, and there were no differences in side effects among the groups. These results suggest that dosages higher than 10 mg/d of haloperidol for most patients have no additional beneficial effect in the treatment of acute or exacerbated schizophrenia.

Acute Disease↗
PubMed1991

Prophylactic antiparkinson drug use: I. Initial prophylaxis and prevention of extrapyramidal side effects.

The use of prophylactic antiparkinson medications during neuroleptic treatment is controversial. Although the efficacy of these agents in the treatment of extrapyramidal side effects is well established, the questions of when to initiate therapy and for how long remain unanswered. There are only a few double-blind, placebo-controlled studies on the value of concurrent antiparkinson drug use at the beginning of neuroleptic treatment. The authors reviewed all studies on initial prophylaxis, and found most to be methodologically deficient. There is evidence to support the use of these agents to prevent acute dystonic reactions. Further work needs to focus on other types of extrapyramidal symptoms. In light of the inability to predict who will experience these side effects, the authors conclude that initial prophylaxis is beneficial for most patients who are starting neuroleptic medications.

Antiparkinson Agents↗
PubMed1991

Prophylactic antiparkinson drug use: II. Withdrawal after long-term maintenance therapy.

Although the efficacy of long-term neuroleptic treatment of schizophrenic patients is generally accepted, the use of concurrent antiparkinson drugs is less well defined. The value of prolonged antiparkinson drug use in preventing extrapyramidal side effects is controversial. More than 30 studies of antiparkinson drug withdrawal have attempted to answer this question. The authors reviewed all double-blind, placebo-controlled studies, and found most to contain serious methodologic or statistical flaws. There is evidence to support the long-term use of these agents in preventing extrapyramidal side effects. The authors offer an analysis of the benefits and risks that are involved with prophylactic antiparkinson drug use, and conclude that most patients would benefit from maintenance therapy.

Antiparkinson Agents↗
PubMed1990

Solving panic disorder problems. When your patients' fears thwart their lives.

All in all, panic disorder with or without agoraphobia is a very satisfying illness to treat. Most patients enter treatment with considerable pain and disability and within a few weeks to months are free of panic attacks, no longer fearful of them, and no longer phobic. Panic disorder must be distinguished from generalized anxiety, and signs of agoraphobia must be sought during the initial diagnosis. Drug therapy is effective for panic disorder, while agoraphobia may respond to drug therapy or to a range of cognitive therapies.

Agoraphobia↗
PubMed1990

Sequence of improvement in agoraphobia with panic attacks.

In a multi-center comparison of alprazolam to placebo in the treatment of agoraphobia with panic attacks, the sequence of sustained remission in both treatment groups, was panic attacks before phobias. This may suggest that phobias are secondary to panic attacks in the pathogenesis of the disorder, although other explanations may account for these data and are discussed.

Adult↗
PubMed1990

Benzodiazepines for anxiety disorders. Are the concerns justified?

Treatment of anxiety disorders deserves the attention of primary care physicians because so many patients have these disorders. Effective treatment is well within the professional repertoire of any physician who chooses to become familiar with the techniques. Aside from the drugs used to treat panic disorder, benzodiazepines are the mainstay of treatment. They are effective and generally safe.

Aged↗
PubMed1990

Dose and blood levels of haloperidol in treatment of mania.

Three doses of haloperidol, 10 mg/day, 30 mg/day, and 80 mg/day, were compared in 47 newly admitted manic patients. There was no difference in outcome within 6 weeks among the three doses. Four blood levels of plasma and red blood cell (RBC) haloperidol and reduced haloperidol showed no linear or curvilinear relationships to clinical response.

Adult↗
PubMed1989

Obsessive-compulsive disorder. How primary care physicians can help.

Obsessive-compulsive disorder is common but not always recognized and treated. Obsessions are recurrent undesirable thoughts or images; compulsions are recurrent undesirable actions. Behavior psychotherapy can be very helpful in controlling compulsions, whereas clomipramine (Anafranil) or fluoxetine (Prozac) therapy can relieve both obsessions and compulsions. Given an understanding of the disorder and its treatment, primary care physicians can, in most cases, effectively diagnose and manage this debilitating condition. Those who do not wish to initiate treatment should refer patients to a mental health professional, as should those who attempt treatment but meet with an unresponsive case.

Humans↗
PubMed1989

Benzodiazepine use and abuse by patients at outpatient clinics.

The charts of 2,719 patients from several outpatient clinics were reviewed for evidence of use and abuse of benzodiazepines. According to the chart data and interviews with physicians, no patient met the criteria for benzodiazepine abuse or dependence.

Aged↗
PubMed1989

Changing patterns of neuroleptic dosage over a decade.

A study of patterns of neuroleptic dosage for 206 schizophrenic inpatients showed significant differences over time and among three centers--a general hospital psychiatric unit, a community mental health center, and a state hospital. In 1982 patients' mean dose at discharge was higher than the peak mean daily dose in 1973, and high-potency neuroleptics were being used almost exclusively. The mean length of stay decreased from 49 days in 1973 to 34 days in 1982. The possible relationship, if any, between increasing dosage, decreased length of stay, and the switch from low-potency to high-potency neuroleptics remains undetermined.

Adolescent↗