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Biomedical subjects

A Rifkin

Publications and source records attributed to A Rifkin.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1988

Depression. Management tips for the primary care physician.

Treatment of major depression can in most cases be handled by the primary care physician who is willing and able to take the time. The minority of patients who pose particular problems in diagnosis or treatment should be referred to a psychiatrist. Primary care physicians are encouraged to regard major depression as being as much within their scope as other common disorders. After pharmacotherapy and office counseling, some patients may need psychotherapy to help them alter patterns of thinking and interaction that contribute to depression.

Antidepressive Agents, Tricyclic↗
PubMed1988

Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. I. Efficacy in short-term treatment.

Following promising preliminary evidence, the benzodiazepine-derivative alprazolam was studied in a large, placebo-controlled, eight-week, flexible-dose trial in patients with agoraphobia with panic attacks and panic disorder. Of 526 patients, 481 completed three weeks of treatment; however, significantly more placebo (102/234) than alprazolam (21/247) recipients subsequently dropped out of the trial, primarily citing ineffectiveness (of placebo) as the reason. Alprazolam was found to be effective and well tolerated. There were significant alprazolam-placebo differences in improvement for (1) spontaneous and situational panic attacks, (2) phobic fears, (3) avoidance behavior, (4) anxiety, and (5) secondary disability, all significant by the end of week 1. At the primary comparison point (week 4), 82% of the patients receiving alprazolam were rated moderately improved or better vs 43% of the placebo group. At that point, 50% of the alprazolam recipients vs 28% of placebo recipients were free of panic attacks.

Adolescent↗
PubMed1988

Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. II. Patient acceptance, side effects, and safety.

In a multicenter placebo-controlled study, the safety, side effects, and patient acceptance of alprazolam for the treatment of panic disorder and agoraphobia were examined. A total of 525 patients meeting DSM-III criteria for agoraphobia with panic attacks or panic disorder were randomly assigned to receive alprazolam or placebo, which they took for eight weeks. The mean daily dose at the end of the study was 5.7 mg of alprazolam or 7.5 capsules of placebo daily. Potentially serious reactions to alprazolam occurred in ten of 263 subjects who received the drug. These included acute intoxication (three), hepatitis (two), mania (two), amnesia (one), aggressive behavior (one), and depression (one). Treatment-related side effects that were worse in patients taking alprazolam than in those taking placebo included sedation, fatigue, ataxia, slurred speech, and amnesia. Sedation was the most frequent but tended to subside with dose reduction or continued administration of the drug. Patient acceptance of alprazolam, as measured by the rate of completion for study participants, was high. Eighty-four percent of patients receiving active drug completed the study compared with 50% receiving placebo.

Adult↗
PubMed1988

Secondary depression in panic disorder and agoraphobia. I. Frequency, severity, and response to treatment.

Depressive symptomatology in 481 subjects with panic disorder and phobic avoidance was studied as part of an investigation of the efficacy of alprazolam in panic disorder. Subjects who had a major depressive episode (MDE) before the onset of their panic disorder were not included in the trial. With this exclusion criterion, 31% of subjects had a secondary MDE occurring after the onset of the panic disorder. The occurrence of secondary MDE was related to the length of time subjects were ill with panic disorder. Compared with the subjects without depression, those subjects with current MDE had higher scores on measures of anxiety and depression but not on the number of panic attacks per week. The presence of depression and the degree of phobic avoidance contributed independently to measures of the severity of the panic illness. Alprazolam was effective in reducing panic and depressive symptomatology in both depressed and nondepressed subjects with panic disorder. The presence of an MDE was not predictive of the outcome of treatment for the panic and phobic symptoms. Subjects with or without depression responded similarly to alprazolam.

Adult↗
PubMed1988

Family attitudes and patient social adjustment in a longitudinal study of outpatient schizophrenics receiving low-dose neuroleptics: the family's view.

Adverse effects of neuroleptic medication have led to the attempt to develop alternative strategies for the treatment of schizophrenia, but it is generally conceded that these strategies may have their own negative outcomes in the form of symptom exacerbation, reduced social performance and worsened family interactions. This paper examines the effect of one such strategy, low doses of medication, on the social adjustment of and family response to chronic schizophrenic outpatients. Patients who were randomly assigned to either a low-dose or standard-dose condition were rated by their families on various aspects of social adjustment. Despite a considerably higher relapse rate in the low-dose condition, families reported patients in the low-dose condition to be no poorer in their social adjustment than standard-dose patients. In addition, families of low-dose patients were more satisfied with their patients' overall level of adjustment and were no more rejecting at endpoint than families of standard-dose patients. Low-dose patients were viewed even more favorably when patients who relapsed were excluded from the analysis. Negative family attitudes, particularly rejection, measured at study entry, were found to predict time to relapse in the low-dose group. Implications for treatment and family intervention are discussed.

Adolescent↗
PubMed1988

ECT versus tricyclic antidepressants in depression: a review of the evidence.

The claim is often made that ECT is more effective and works more rapidly than antidepressant drugs in the treatment of depression. The author reviews the nine controlled studies comparing the two treatments that appear in the literature. All of the studies were methodologically deficient, especially concerning definition of depression, sample size, dose of drug, and statistical analysis. No conclusive answer is available to the question whether ECT is superior to antidepressants in the treatment of depression. Pivotal studies are needed.

Antidepressive Agents↗
PubMed1987

Adjunctive imipramine in the treatment of postpsychotic depression. A controlled trial.

The efficacy of adjunctive imipramine hydrochloride treatment for syndromally defined postpsychotic depression was assessed in a six-week, double-blind, placebo-controlled study. All patients had been diagnosed as having schizophrenia or schizoaffective disorder, all were receiving stable doses of fluphenazine decanoate, and all had received benztropine mesylate in an attempt to rule out neuroleptic-induced akinesia. Patients randomized to imipramine therapy fared significantly better in terms of their global improvement and in terms of individual symptoms that are components of the depression syndrome. There were no significant differences in outcome psychosis ratings or side effects. This study indicates the existence of an identifiable syndrome of secondary depression in this patient group that is likely to respond favorably to treatment with adjunctive imipramine.

Adult↗
PubMed1987

Extrapyramidal side effects: a historical perspective.

A historical review of the adverse reactions to neuroleptic agents--extrapyramidal side effects--is presented. Soon after its introduction in 1952, chlorpromazine was noted to induce symptoms resembling Parkinson's disease. At first, these symptoms were thought to be related to the drug's antipsychotic effect. Later, more careful research showed that they are not directly associated with the antipsychotic activity of neuroleptic agents. More recently, extrapyramidal side effects have gained importance because they are significant factors in both the patient's acceptance of the particular drug and his or her social adjustment.

Adult↗
PubMed1986

Facial discrimination and emotional recognition in schizophrenia and affective disorders.

Current research demonstrates that patients with schizophrenia display deficits in a broad range of interpersonal skills. To investigate the ability of patients with schizophrenia and major depression and normal controls to process facial stimuli, four tasks were constructed from 21 photographs of faces representing standardized poses of fundamental emotions. Two tasks were designed to investigate facial identity matching independent of emotion expressed, and two tasks were designed to test emotion recognition and emotion labeling, respectively. Results indicate that while depressed patients differed from controls only on the emotion-labeling task, those with schizophrenia showed deficits on all four tasks when compared with controls and did worse than patients with depression on the emotion tasks. The findings suggest that patients with schizophrenia are impaired on a broader range of facial perception skills than those with depression, when compared with controls.

Adult↗
PubMed1986

Exacerbation of schizophrenia associated with amantadine.

Administration of amantadine was associated with psychotic decompensations in two schizophrenic patients being maintained on concomitant neuroleptic medication. Despite a postulated dopaminergic mechanism, there seems to have been only one previous report of amantadine's precipitating psychosis in a schizophrenic patient.

Acute Disease↗
PubMed1986

Psychotropic medication in adolescents: a review.

All published articles of double-blind, controlled studies of drug treatment of mental disorders in adolescents are reviewed. The evidence for efficacy ranges from suggestive to nonexistent, without any match of drug and disorder showing definitive evidence, either because of the limited number of studies available or because these studies have less than clear findings. Special considerations in the study of adolescent psychopharmacology are addressed, and a practical approach to drug treatment making the best use of the limited information available is offered.

Adolescent↗