Biomedical subjects

A Stoudemire

Publications and source records attributed to A Stoudemire.

At least 37 records · Page 2Linked to original sources

PubMed1993

Psychopharmacologic treatment of anxiety in the medically ill elderly patient: special considerations.

The use of psychotropic agents to treat anxiety in medically ill elderly patients requires consideration of special pharmacokinetic and pharmacodynamic factors in drug selection. In this review, the use of seven general classes of psychotropic drugs with anxiolytic activity will be considered for use in the medically ill: benzodiazepines, azapirones, cyclic (non-monoamine oxidase [MAO] inhibitor) antidepressants, beta-adrenergic blocking agents, antihistamines, neuroleptics, and MAO inhibitors. Attention will be given to developing rational strategies for drug selection in order to minimize deleterious side effects, to which medically ill elderly patients may be vulnerable.

Age Factors↗

PubMed1992

Electroconvulsive therapy and the chronic use of pseudocholinesterase-inhibitor (echothiophate iodide) eye drops for glaucoma. A case report.

A case is presented in which a patient who required treatment with electroconvulsive therapy had a history of being treated with pseudocholinesterase-inhibitor eye drops (echothiophate iodide) for glaucoma. As treatment with this antiglaucoma agent contraindicated the use of succinylcholine for a minimum of 10-14 days, the short-acting nondepolarizing agent atracurium was employed instead. The anesthetic management of this patient is described as a guide for clinicians facing similar clinical situations.

Aged↗

PubMed1992

Pathophysiology and management of phantom limb pain.

Phantom pain phenomenon is a poorly understood but relatively common sequela of limb amputation that may result in significant psychological and physical morbidity. In this review, proposed pathoneurophysiological mechanisms for the development of phantom pain are reviewed as well as psychological mechanisms that may be involved. The authors recommend an integrated approach to management of chronic phantom pain that takes into consideration the multiple factors that may contribute to its etiology.

Adult↗

PubMed1992

Terminal cardiomyopathy, splitting, and borderline personality organization.

A 63-year-old married man with idiopathic terminal cardiomyopathy was admitted to the medical service for treatment of advanced heart failure. A psychiatric consultation was requested to assist the medical treatment team in dealing with the patient's abusive behavior. The case is presented and discussed within the context of understanding the borderline personality in the medical setting.

Adaptation, Psychological↗

PubMed1992

Organic mood disorder associated with the HAIR-AN syndrome.

The HAIR-AN syndrome is characterized by hyperandrogenism, insulin resistance, and acanthosis nigricans. The authors report the first case of an organic mood disorder associated with this condition that improved markedly in response to ovarian suppression with oral contraceptives. The proposed pathophysiology of this syndrome is also discussed.

Acanthosis Nigricans↗

PubMed1992

Dysnomia in the differential diagnosis of major depression, depression-related cognitive dysfunction, and dementia.

This study examined naming abilities in three groups of older adults with: I) major depression alone, II) major depression with reversible cognitive dysfunction, and III) dementia with depression. Groups I and II differed significantly from dementia patients in total correct responses to a visual-confrontation naming task (Boston Naming Test). Qualitative aspects of naming, specifically types of errors characterizing each patient group, were examined, but no statistically significant differences among groups were observed. The results support the contention that the presence of dysnomia may be useful in discriminating cognitive abnormalities secondary to dementia from cognitive dysfunction associated with depression.

Aged↗

PubMed1992

Factitious apraxia.

A case is described in which a patient had pseudoneurological symptoms that were present only upon direct observation or when the patient was in clinical test situations. The differential diagnosis of apraxia is discussed as well as clinical suggestions for evaluating patients with suspected factitious apraxia.

Adult↗

PubMed1992

Sleep disorders in the medically ill patient.

A careful medical evaluation is essential for any patient complaining of disturbed sleep so as to ascertain the contribution of possible metabolic, neurologic, or medication-related factors to symptom development. In this review, medical and neurologic conditions that may negatively affect sleep will be discussed as well as commonly offending medications. Special attention will be given to sleep apnea syndromes. The evaluation of sleep disturbance in the medical patient will be discussed with focus on of the special pharmacokinetic considerations involved in selecting medications for the treatment of disturbed sleep in this patient population.

Benzodiazepines↗

PubMed1991

Somatothymia.

The development of affective language is a complex process that may be influenced by sociocultural, psychodynamic, developmental, cognitive, and behavioral factors. This article, published in two parts, discusses the multidimensional factors influencing the acquisition and expression of affective language. The terms somatothymia and somatothymic language, derived from the concept of alexithymia, are introduced to describe the phenomenon of utilizing somatic language to communicate psychological distress.

Affective Symptoms↗

PubMed1991

Psychological and behavioral factors affecting medical conditions and DSM-IV. An overview.

As part of the process of reevaluating the category Psychological Factors Affecting Physical Condition (PFAPC) for possible revisions in DSM-IV, a coordinated review of the literature was conducted to document the extent of empirical evidence that exists for an association between psychological factors affecting the onset, exacerbation, course, and outcome of medical disorders. In this introduction and overview, the authors discuss the methodology and purpose of the reviews, as well as the reasons for considering revisions in the PFAPC category. Relevant historical concepts in psychosomatic medicine are briefly reviewed, and an argument is made that the general scope of the PFAPC category should be broadened in DSM-IV to include behaviorally related factors of major public health concern, as well as the effects of psychiatric comorbidity on medical outcome.

Arousal↗

PubMed1991

Psychotropic drug use in the medically ill. Part II.

Underlying medical illness and drug interactions may make the use of psychotropic agents problematic in some physically ill patients. This overview, published in two parts, discusses six major classes of psychotropic medications (cyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines, neuroleptics, lithium, psychostimulants, and carbamazepine) and examines their use in the setting of specific types of medical illnesses (e.g., cardiovascular, pulmonary, hepatic, and renal disease). Practical considerations in using psychotropic medications in medical-surgical patients--particularly those who are elderly or medically debilitated--will receive special emphasis.

Drug Interactions↗

PubMed1991

Cognitive outcome following tricyclic and electroconvulsive treatment of major depression in the elderly.

OBJECTIVE: This study sought to ascertain the affective and cognitive outcome after tricyclic and electroconvulsive treatment of elderly medical-psychiatric patients meeting diagnostic criteria for major depression, some of whom had normal cognitive functioning and some of whom were cognitively impaired before treatment. METHOD: Patients who met criteria for major depression on the basis of a structured diagnostic interview and who scored 17 or more on the Hamilton Rating Scale for Depression were evaluated with the Mattis Dementia Rating Scale. The patients were then treated in a nonrandom manner with either tricyclic antidepressants or ECT (followed by tricyclic maintenance therapy). The majority of the patients treated with ECT had not responded previously to tricyclics. Follow-up psychometric testing was repeated in 6 months. RESULTS: Among the patients with normal pretreatment cognitive functioning, cognition was generally stable. Among the patients with pretreatment cognitive impairment, a substantial number--including those receiving ECT--demonstrated improvement in cognition. While the majority of patients improved with respect to both their affective and cognitive states, certain treatment-refractory subgroups were nevertheless identified. CONCLUSIONS: The data suggest that cognitive dysfunction associated with depression may improve after treatment in a substantial number of elderly patients, including those receiving ECT. Relapse rates, however, may be relatively high, and residual symptoms may persist, which emphasizes the need for optimal initial and long-term antidepressant strategies for this population.

Aged↗

PubMed1991

The medical-psychiatric unit as a site for outcome research in dementia/depression syndromes.

The era of cross-sectional "snapshot" clinical epidemiology studies in consultation-liaison psychiatry, while still important, do not in themselves yield the critical outcome information needed to document both the clinical efficacy and cost-efficacy of timely psychiatric treatment of patients with concurrent medical-psychiatric illness. As consultation-liaison psychiatry has been plagued by problems regarding reimbursement for clinical services rendered and has only a few systematic outcome studies as yet documenting the effectiveness of treatment interventions, more prospective studies are desperately needed to confirm the value of our efforts. The era of proselytizing the virtues of consultation-liaison psychiatry is over, and as with every other area of psychiatric therapy, governmental policy makers and third party payors are appropriately demanding to see "proof" that our treatments are both clinically- and cost-effective. As may be seen from this brief overview of our research demonstrating the potential reversibility of disabling cognitive dysfunction in depressed medical-psychiatric patients and the efficacy of labetalol in decreasing cardiovascular complications from ECT in high risk medical patients, positive reports from clinical investigations that are strategically planned and implemented on specific populations form strong arguments for the clinical and probable cost efficacy of both consultation-liaison psychiatry and medical-psychiatric units.

Comorbidity↗

PubMed1990

Development of a medical-psychiatric program within the private sector. Potential problems and strategies for their resolution.

Recent reports regarding the development of combined medical-psychiatric units have primarily involved units operated under the auspices of academic medical centers. Almost no published information is available regarding the fiscal, administrative, or clinical feasibility of operating such programs within the context of the private community hospital setting. This article outlines the organization and development of such a private unit and discusses the various medical, administrative, political, and financial considerations that must be evaluated in planning for the successful operation of medical-psychiatric units within the private sector.

Cost Control↗

PubMed1990

Psychotropic drug use in the medically ill: Part I.

Underlying medical illness and drug interactions may make the use of psychotropic agents in some physically ill patients problematic. This overview, published in two parts, discusses six major classes of psychotropic medications (cyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines, neuroleptics, lithium, psychostimulants, and carbamazepine) and examines their use in the setting of specific types of medical illnesses (e.g., cardiovascular, pulmonary, hepatic, and renal disease). Practical considerations in using psychotropic medications in medical-surgical patients, particularly those who are elderly or medically debilitated, receive special emphasis. In part I, the use of cyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines, and buspirone are discussed.

Drug Interactions↗

PubMed1990

Behavioral and pharmacologic management of patients with Alzheimer's disease.

While as yet there are no proven effective primary treatments for Alzheimer's disease, physicians play a critical role in the evaluation and long-term supportive care of these patients and their families. The physician also plays a pivotal role in helping the patient make management decisions regarding their loved one such as organizing the process of nursing home placement in the more advanced phases of the illness. In addition, physicians provide a focal point for triage community support resources, such as the Alzheimer's Association. When necessary, the judicious and conservative use of psychopharmacologic agents can serve to partially diminish the pervasive behavioral complications of this illness.

Aged↗

PubMed1990

Labetalol in the control of cardiovascular responses to electroconvulsive therapy in high-risk depressed medical patients.

Labetalol, a drug with alpha- and beta-adrenergic receptor blocking effects, was used to attenuate hypertension and tachycardia associated with electroconvulsive therapy (ECT) in a series of 11 elderly patients with refractory depression and cardiovascular disease in a placebo-controlled, double-blind crossover study design. As compared with placebo, labetalol was found to blunt mean arterial pressure (MAP) increase by up to 8.26% (p less than .001), heart rate increased by up to 26.07% (p less than .001), frequency of atrial arrhythmias by up to 100% (p less than .01), and premature ventricular contractions by 41.97%. No untoward side effects were observed, and no effect on treatment outcome was noted. Labetalol appears to be an effective and safe agent to use in decreasing hypertension, tachycardia, and possibly arrhythmias in high-risk medical patients with cardiovascular disease undergoing ECT.

Aged↗

PubMed1989

Occupational therapy program development for medical-psychiatry units: a cognitive model.

Occupational therapy programs form an essential component of the overall treatment program on medical psychiatry units for patients with depression, physical debilitation, and cognitive dysfunction. This article outlines theoretical and practical aspects of developing an occupational therapy program for medical-psychiatric inpatients. Emphasis is placed on accurate assessment of cognitive and physical functioning to facilitate stratification of patients into appropriate therapeutic activities that are commensurate with their level of functioning. The theoretical basis and orientation of occupational therapy is also discussed vis-à-vis its relevance to the treatment of patients with concurrent medical and psychiatric illness.

Adolescent↗