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Biomedical subjects

A Stoudemire

Publications and source records attributed to A Stoudemire.

99 records · Page 6Linked to original sources
PubMedDate not supplied

The Academy of Psychosomatic Medicine practice guidelines for psychiatric consultation in the general medical setting. The Academy of Psychosomatic Medicine.

This practice guideline seeks to provide guidance to psychiatrists who regularly evaluate and manage patients with medical illnesses. The guideline is intended to delineate the knowledge base, professional expertise, and integrated clinical approach necessary to effectively manage this complex and diverse patient population. This guideline was drafted by a work group consisting of psychiatrists with clinical and research expertise in the field, who undertook a comprehensive review of the literature. The guideline was reviewed by the executive council of the Academy of Psychosomatic Medicine and revised prior to final approval. Some of the topics discussed include qualifications of C-L consultants, patient assessment, psychiatric interventions (e.g., psychotherapy, pharmacotherapy), medicolegal issues, and child and adolescent consultations.

Adolescent↗
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Psychopharmacologic treatment of depression in the medically ill.

Appropriate selection of an antidepressant agent in medically ill patients requires a careful risk-benefit assessment matching the pharmacokinetic and pharmacodynamic properties of the drug being considered against the patient's physiological vulnerabilities, potential for drug interactions, and primary symptoms of the patient's depression. While in the past antidepressant drug selection was limited by the almost sole availability of the tricyclic antidepressants, newer drugs such as selective serotonin reuptake inhibitors, bupropion, and venlafaxine have vastly simplified treating depression in the medically ill. In refractory cases of depression in patients with medical illness, electroconvulsive therapy can be used with appropriate anesthetic management.

Antidepressive Agents↗
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Neuropsychiatric toxicity associated with cytokine therapies.

The cytokines interleukin-2 and interferon-alpha are potent biological agents used to treat malignancy, infectious diseases, and neurodegenerative disorders. While these medications show substantial therapeutic promise, the neuropsychiatric toxicity associated with these agents is often treatment-limiting. The pathophysiology of this toxicity is not well delineated, and adverse effects to the central nervous system are often misdiagnosed by clinicians. This report reviews the preclinical and clinical literature describing the morbidity associated with these agents and suggests appropriate clinical management strategies and future directions for research.

Antineoplastic Agents↗
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Qualitative outcome assessment of a medical ethics program for clinical clerkships: a pilot study.

This study assessed the usefulness of an open-ended case analysis test instrument for evaluating the effects of a 1-year ethics course on medical students' decision-making skills. Through case-oriented seminars in gynecology, internal medicine, obstetrics, pediatrics, psychiatry, and surgery, third-year medical students were taught a structured analytic framework for analyzing clinical ethical problems stressing the interactive relationships among medical indications, patient preferences, quality of life, and contextual (social, legal, economic) matters. At precourse, the students were given a test case and asked to provide a line of reasoning for their clinical decisions. At postcourse, the students were given the same case. Content analysis of pre- and postcourse responses of a random student sample revealed increases in student awareness in the following areas: 1) consideration of informed consent, 2) professional liability, 3) physician-assisted suicide, and 4) resource utilization. With some modifications, open-ended case analysis holds promise for evaluating medical ethics courses. The authors make recommendations for future research in evaluating the true impact of clinical ethics courses in medical education.

Clinical Clerkship↗
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Quo vadis, psychiatry? Problems and potential for the future of medical student education in psychiatry.

Psychiatric education occupies a relatively low status level in most academic departments of psychiatry. This problem may be in part because career teachers rarely generate sustained external grant support. Their salaries may be regarded as perpetual drains on the budgets of department chairs. The author explores a possible relationship between the decline in the emphasis on psychiatric education and the decline in the number of medical students entering psychiatric residency programs. Recommendations for improvement in the support of psychiatric education are made that focus on greater accountability of how tuition fees are distributed to support the salaries of faculty educators. The unique role that consultation-liaison (C-L) psychiatry occupies in psychiatric education, the effects of managed care on C-L psychiatry, and the special problems that C-L psychiatry currently faces with its strong emphasis on non-reimbursable educational activities are discussed. Revitalization of the importance of education in undergraduate medical education is vital for the future of psychiatry.

Career Choice↗
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Family physicians' perceptions of psychosocial disorders: survey report and educational implications.

One-hundred seventy-seven family physicians were surveyed regarding their perceptions of the types of psychosocial problems encountered in their practices, the amount of time they felt they devoted to each problem, and their interests regarding continuing psychiatric education. Patients with "multiple somatic complaints" and "symptoms of emotional distress" were reported as being encountered most frequently. Marital and family problems, alcoholism and sexual dysfunction were also ranked highly. The physicians indicated the highest interest in managing these disorders in addition to treatment of the suicidal patient. The implications of these results for psychiatric educators and liaison psychiatrists are discussed. The authors recommend using DSM-III diagnostic criteria applicable to these syndromes in formulating educational programs for primary care physicians.

Adolescent↗
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Effects of a psychiatric liaison program on internists' ability to assess psychosocial problems.

The ability to assess psychosocial problems of a group of primary care internal medicine residents education in a relatively unstructured psychiatric liaison program was compared to a group of internists who had no specialized psychiatric training. The primary care residents did not demonstrate a superior ability to assess patients' psychosocial problems when compared to internists without such training. The effectiveness of such unstructured liaison experiences (i.e., the Balint model of group supervision and teaching conferences) is questioned. The authors suggest that the main benefit of such informal approaches may lie in gaining initial attitudinal and administrative acceptance by nonpsychiatric physicians of liaison teaching programs. Formally structured, supervised learning experiences are probably necessary to effectively enhance internists' clinical skills and behaviors in dealing with the psychosocial and psychiatric aspects of medical care.

Colorado↗
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Effects of depressive disorders on coronary artery disease: a review.

Evidence suggests that major depression and ischemic heart disease commonly co-occur and that depressive symptoms have a negative impact on cardiovascular prognosis. A Medline search was conducted to obtain articles published between 1966 and 1996 that address the association between depressive disorders and coronary artery disease. We used systematic epidemiologic criteria to examine the strength of this association. There is convincing evidence that in patients with coronary artery disease, depressive disorders are common and are associated with increased rates of morbidity and mortality. Several biological mechanisms have been proposed to explain the association, including alterations in autonomic function leading to increased risk of ventricular arrhythmias. Despite the evidence that their comorbid presence is associated with increased morbidity and mortality, depressive disorders in patients with coronary artery disease are often underdiagnosed and inadequately treated. At the very least, randomized treatment trials are indicated.

Coronary Disease↗