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Biomedical subjects

B A Kramer

Publications and source records attributed to B A Kramer.

32 records · Page 2Linked to original sources
PubMed1987

Electroconvulsive therapy use in geriatric depression.

A retrospective review of elderly patients who received electroconvulsive therapy (ECT) over an 18-month period found ECT to be safe and effective. Of the 1159 patients admitted to the psychiatric unit during this time period, 50 patients (4.3%) aged 61 to 88 received between two and 14 ECT treatments. Brief pulse current with bilateral electrode placement and electroencephalogram monitoring were used with each patient. A total of 46 patients (92%) were much improved after ECT. Of the four nonresponders, three terminated treatment prematurely due to increased confusion, and one failed to respond after a course of 12 ECT treatments. There were no medical complications related to the ECT. A mean of 4.93 months from the onset of symptoms until receiving ECT may be one factor in our better outcome compared to some recent studies where treatment was delayed. The exclusive use of brief pulse current and its resultant lower level of confusion also may be important.

Age Factors↗
PubMed1986

Severe confusion in a patient receiving electroconvulsive therapy and atenolol.

Atenolol is a beta-blocker antihypertensive agent that reportedly has little central nervous system action. A patient was given atenolol during a course of electroconvulsive therapy and developed an organic mental syndrome with paranoid delusions. The possible alteration of the permeability of the blood-brain barrier by electroconvulsive therapy may have enabled atenolol to cause this unusual side effect.

Aged↗
PubMed1986

Atropine and glycopyrrolate as ECT preanesthesia.

Twenty-four patients receiving ECT were systematically studied to compare the effects of two dosages of atropine and two dosages of glycopyrrolate as preanesthetic agents. Glycopyrrolate resulted in more cardiac arrhythmias, nausea and vomiting, and episodes of bradycardia than atropine (p = .4). More patients receiving atropine showed post-ECT confusion, but the clinical impact of this was minimal. Atropine appears to be preferable to glycopyrrolate for use in ECT preanesthesia.

Adolescent↗
PubMed1985

Use of ECT in California, 1977-1983.

The author examined the use of ECT in California from 1977 to 1983, a period during which its availability steadily declined. Approximately 1.12 persons per 10,000 population received ECT in 1977-1983, with little variation from year to year. Most ECT was paid for with nonpublic funds by white patients in nongovernmental facilities. The probability of receiving ECT increased with the age of the patient. ECT was quite safe: no fractures were reported, and the mortality rate was 0.2 deaths per 10,000 treatments. Despite restrictive regulation and limited availability, ECT continues to be used in California.

Adolescent↗
PubMed1979

The effects of a psychiatric liaison program on the utilization of psychiatric consultations: an evaluation by chart audit.

The effects of a psychiatric liaison program were studied by a chart audit examination of psychiatric consultations on a medical service. A comparison of the full liaison ward with the other wards revealed significant differences in the use of emergency consultation and psychiatric follow-up treatment. The results indicated improved psychologic management of medical patients on wards with intense liaison involvement but no measurable change in attitude toward the psychiatrist. Evaluation methodology and implications of the results are discussed.

Adult↗
PubMed1978

Circadian temperature variation and depressive illness.

Circadian temperature rhythms were studied at different clinical phases in inpatients admitted with a diagnosis of depression. It was found that patients meeting diagnostic criteria for either bipolar or unipolar II classification had a significantly greater likelihood of having an altered temperature rhythm while clinically depressed. The implications of this finding are discussed and questions for future research are specified.

Adjustment Disorders↗
PubMed1978

A study of former mental patients who returned to visit the ward on which they were hospitalized.

We have observed that former psychiatric inpatients often return to visit the ward after they have been discharged. Nothing has been written about this phenomenon, but it seemed to us that since not all discharged patients return to visit, a difference must exist between those who do visit and those who do not. The following report presents the results of our investigation into the distinguishing characteristics of the visiting ex-patients. Reider (1953) and Safirstein (1967, 1970) have described the phenomenon of institutional transference, which deals with patients' attachment to the institution rather than to an individual therapist. However, our data show that the phenomenon of former patients visiting goes beyond that, in some instances reflecting meaningful relationships with staff members and other patients, but in other instances indicating continuing treatment needs of various kinds.

Adolescent↗
PubMedDate not supplied

A teaching guide for electroconvulsive therapy.

Concern has been raised regarding the erratic and sometimes less than adequate teaching of electroconvulsive therapy (ECT) to health professionals. The development of standardized curricula will ultimately improve the quality of care for patients receiving ECT and help to minimize the myths and misinformation clinicians have regarding ECT. An outline for teaching ECT is presented that covers the following areas: preconceptions, history, patient selection, conditions of increased risk, medical and neurological side effects, memory issues, technical aspects, electrode placement, clinical problems, management of the post-ECT course, legal and ethical issues, mechanisms of action, and educational issues. This outline can be expanded to encompass up to a 6-hour course for psychiatric residents, or compressed to provide the basics to nursing, medical, or pharmacy students.

Curriculum↗
PubMedDate not supplied

A naturalistic comparison of adverse effects between slow titration and loading of divalproex sodium in psychiatric inpatients.

BACKGROUND: This study compares the incidence, severity and onset of treatment-emergent adverse effects between slow titration and loading of divalproex sodium in psychiatric inpatients. METHOD: Forty-seven patients were prescribed either loading or slow titration of divalproex sodium. Under single-blind conditions, adverse effects were assessed using a valproate adverse effects rating scale. Except for a statistically significant greater incidence of somnolence in the slow titration group, no statistically or clinically significant differences in incidence, severity or onset of treatment-emergent adverse effects were found between groups. RESULTS/CONCLUSION: Overall, adverse effects were well tolerated by both groups.

Adult↗