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Biomedical subjects

C Salzman

Publications and source records attributed to C Salzman.

At least 37 records · Page 2Linked to original sources
PubMed1995

Effect of fluoxetine on anger in symptomatic volunteers with borderline personality disorder.

Clinical data and uncontrolled observations have suggested that fluoxetine is helpful in some patients with borderline personality disorder. This article describes the results of a 13-week double-blind study of volunteer subjects with mild to moderately severe borderline personality disorder. Thirteen fluoxetine recipients and nine placebo recipients received treatment. Pretreatment and posttreatment measures were obtained for global mood and functioning, anger, and depression. The most striking finding from this study was a clinically and statistically significant decrease in anger among the fluoxetine recipients. This decrease was independent of changes in depression. These data support previous observations that fluoxetine may reduce anger in patients with borderline personality disorder. The number of subjects in this study was small, the placebo responsiveness was high, and the clinical characteristics of the patients were in the mild to moderate range of severity. The data cannot be extrapolated to more severely ill borderline patients, but further study of fluoxetine and other selective serotonin reuptake inhibitors is indicated in this population.

Adult↗
PubMed1995

Depression in a long-term care facility: clinical features and discordance between nursing assessment and patient interviews.

OBJECTIVE: Nurses commonly observe more depression than is diagnosed and treated in nursing homes. Accordingly, we aimed to describe the clinical features of untreated nursing home residents whom nurses identify as depressed and to compare nurse ratings of depressed nursing home residents with ratings from direct interviews and patient self-reports. DESIGN: Cross-sectional survey followed by semi-structured diagnostic interviews of depressed patients and their nurses. SETTING: A large academic, multi-level, long-term care facility. PARTICIPANTS: Thirty-seven patients aged 74-99 (mean age 88.4) whom nurses identified as having daily symptoms of depression. Subjects had Mini-Mental State Exam (MMSE) scores > 10 (mean score 21.2), were not acutely or terminally ill, and were able to participate in an interview. MEASUREMENTS: DSM-III-R mood diagnoses and separate ratings of interviews with nurses and patients using the Cornell Scale for Depression. RESULTS: Nurses observed daily symptoms of depression in 110 of 495 (22%) long-term care residents on units not reserved for advanced dementia. Of these 110 patients, 58 (53%) were not receiving antidepressants. Of 37 patients eligible for interviews, nine met criteria for major depression, 20 met criteria for another non-major depression diagnosis, and eight did not have a diagnosable mood disorder. Cornell scale ratings derived exclusively from interviews of nurses were similar across the three diagnostic groups (12.5, 9.9, and 9.5, respectively; P = .31; mean 10.5), whereas Cornell scale ratings from patient interviews differed among groups (15.9, 6.9, and 4.1, respectively; P < .001; mean 8.4). Correlation between nurse Cornell ratings and patient Cornell ratings was poor (r = .27), especially for patients with non-major forms of depression (r = -.20). MMSE and Cumulative Illness Rating Scale (CIRS-G) scores were similar in the three groups. CONCLUSIONS: Nurses frequently observed symptoms of depression in a long-term care setting, and many symptomatic patients were not being treated with antidepressants. In these patients, nurse-derived symptom ratings did not vary across DSM-III-R diagnostic categories and correlated poorly with ratings from direct patient interviews. These findings suggest that nurse caregivers may contribute important diagnostic information about non-major depression and raise questions about the application of standard diagnostic categories to late-life depression in the nursing home.

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PubMed1995

Medication compliance in the elderly.

The consequences of drug noncompliance may be serious in older patients. Estimates of the extent of noncompliance in the elderly vary, ranging from 40% to a high of 75%. Three common forms of drug treatment noncompliance are found in the elderly: overuse and abuse, forgetting, and alteration of schedules and doses. Some older patients who are acutely ill may take more than the prescribed dose of a medication in the mistaken belief that more of the drug will speed their recovery. Such overuse has clearly been associated with adverse drug effects. Forgetting to take a medication is a common problem in older people and is especially likely when an older patient takes several drugs simultaneously. Data suggest that the use of three or more drugs a day places elderly people at particular risk of poor compliance. The use of at least three drugs, and often more, is common in the elderly, with estimates of as many as 25% of older people taking at least three drugs. Averages of drug use among elderly hospitalized patients suggest that eight drugs taken simultaneously may be typical. Problems may also arise when dementia or depression is present, which may interfere with memory. The most common noncompliant behavior of the elderly appears to be underuse of the prescribed drug. Inappropriate drug discontinuation, furthermore, may occur in up to 40% of prescribing situations, particularly within the first year of a chronic care regimen. As many as 10% of elderly people may take drugs prescribed for others; more than 20% may take drugs not currently prescribed by a physician.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Anxiety in the elderly. Course and treatment.

Despite increasing research interest in the area of anxiety in younger age groups, few systematic studies of the course and treatment of anxiety disorders in the elderly have been performed. Data from Epidemiologic Catchment Area (ECA) studies suggest that anxiety disorders remain among the most prevalent of all psychiatric disorders in this age group. There is little information available about the late onset of anxiety disorders except for some evidence regarding panic disorder that suggests a distinct subtype with late onset and differences in vulnerability factors and phenomenology. Any evaluation of anxiety in the elderly should take into account multiple medical illnesses and medications that can produce a similar symptom picture. Thus, the importance of good history-taking, empathy to the patient's psychosocial situation, and awareness of the possibility of an underlying medical condition cannot be overemphasized. A variety of compounds including benzodiazepines, buspirone, antidepressants, and beta blockers seems to show effectiveness for various anxiety disorders of the elderly. One needs to be cognizant of the great individual variation among the elderly and should be ready and willing to tailor usage of medications or cognitive-behavioral techniques to the patient's special needs. Proper education of the patient, leading to better compliance with the treatment regimen, and recent advances in treatment will almost certainly improve the outlook for these patients in the future for better functioning and a more optimistic prognosis.

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PubMed1994

Clozapine following ECT: a two-step treatment.

BACKGROUND: Some candidates for clozapine treatment may be unable to be given the drug. They may be so severely ill that they cannot or will not ingest a pill; their psychosis may have so compromised their physical status that use of clozapine, which produces a broad range of side effects, would be unsafe; and/or they may require a very rapid control of their behavior. METHOD: Two case reports are described of patients who, although candidates for clozapine, were unable to take or be given the drug. Initial treatment with electroconvulsive therapy (ECT) was tried in both patients prior to use of clozapine. RESULTS: In the two cases described, treatment with ECT prior to clozapine stabilized the patients enough that clozapine could be administered. In both cases, the clozapine appeared to perpetuate the initial clinical response produced by the ECT. CONCLUSION: These case reports suggest that a two-step strategy of ECT followed by clozapine treatment may both facilitate the use of clozapine in some patients and perpetuate the clinical stability produced by ECT alone.

Adult↗
PubMed1993

Benzodiazepine treatment of panic and agoraphobic symptoms: use, dependence, toxicity, abuse.

Benzodiazepines are widely prescribed drugs. Most patients are prescribed benzodiazepines for short periods of time for anxiolytic or hypnotic purposes. However, some benzodiazepines are also used for extended periods at high doses to treat panic and agoraphobic disorders. When chronically prescribed benzodiazepines are discontinued, a predictable pattern of discontinuance symptoms may develop, indicating physiological dependence. Benzodiazepines also produce a variety of side effects including sedation, reduced coordination, and impaired cognition, which are primarily related to dose and duration of treatment. Benzodiazepines are commonly used by polysubstance abusers but their abuse as recreational drugs when taken alone is rare, and high-dose treatment for panic and agoraphobic symptoms does not lead to abuse. Prescribing guidelines are offered.

Agoraphobia↗
PubMed1993

Clozapine response and plasma catecholamines and their metabolites.

The atypical neuroleptic clozapine has an unusual profile of clinical effects and a distinctive spectrum of pharmacological actions. Plasma measures of catecholamines and their metabolites have been used in the past to study the action of typical neuroleptics. We obtained longitudinal assessments of plasma measures of dopamine (pDA), norepinephrine (pNE), and their metabolites, homovanillic acid (pHVA) and 3-methoxy-4-hydroxyphenylglycol (pMHPG), in eight treatment-resistant or treatment-intolerant schizophrenic patients who were treated with clozapine for 12 weeks following a prolonged drug-washout period. Our findings from the study of these eight patients suggest the following: Plasma levels of HVA and possibly NE derived from the neuroleptic-free baseline period may predict response to clozapine; plasma levels of HVA and MHPG decrease during the initial weeks of treatment in responders but not in nonresponders; and plasma levels of DA and NE increase in both responders and nonresponders to clozapine.

Adult↗
PubMed1993

Pharmacologic treatment of depression in the elderly.

Depressive illness is the most common emotional disorder in those of advanced age, occurring in approximately one seventh of those over 65 years old. Despite its high prevalence, depression in the elderly is more complicated to diagnose and treat than depression in younger adults. Successful pharmacotherapy for depression in the elderly requires careful consideration of the pharmacodynamics and pharmacokinetics of antidepressant medications of various classes to balance the therapeutic effects and side effect profiles of these agents. The heterocyclic antidepressants are effective in the elderly, but their use in this population may be limited by anticholinergic and/or cardiovascular side effects. The monoamine oxidase inhibitors also are effective, but compliance problems limit their usefulness in older persons. The serotonin selective reuptake inhibitors have been shown to be effective in the elderly, and their side effect profiles are generally milder than those of the older agents. Elderly patients receiving psychotropic drug therapy must be monitored carefully because treatment failure due to undermedication and drug toxicity due to overmedication may have more severe consequences in older than in younger adults.

Age Factors↗
PubMed1992

Monoamine oxidase inhibitors and atypical antidepressants.

The following conclusions may be drawn from this article: 1. The age at which subjects are considered "elderly" or "geriatric" varies from study to study. By convention, age 65 is usually taken as the minimum age, yet virtually all studies cited included subjects below 65. Indeed, in a majority of studies, most of the subjects were below the conventional age of 65. Defining the minimum age for geriatric psychopharmacology studies is particularly important because there may be considerable pharmacodynamic and pharmacokinetic heterogeneity in people aged 65 and older. Clinical experience suggests that patients below age 80 tend to respond to medications like late middle-age adults, whereas those above age 80, as a group, are more sensitive to drugs. Because people 80 and above constitute the fastest growing group of Americans, it is essential to conduct more therapeutic clinical trials using them as research subjects. Information gathered from persons aged 60 to 79 may not be relevant to this older age group. 2. The total number of individuals studied in carefully controlled, double-blind research studies of MAOIs, atypical antidepressants, or psychomotor stimulants are relatively few when compared with the number of individuals studied with tricyclic antidepressants, or the number of nonelderly subjects studied. 3. Although many older persons are included in mixed-age research populations, the number of studies specifically designed in the elderly is also remarkably few. 4. In those studies that did focus on older patients, the definition of elderly was extended "downward" to include patients at age 55, or even 50. Whether or not this was done in order to enhance research subject recruitment, the net result is to vitiate any overall conclusion regarding the efficacy of drugs in patients over age 65, the usual lower cutoff for "elderly" or "geriatric" definition. 5. With the exception of a handful of patients receiving fluoxetine and methylphenidate, virtually no research patient above the age of 80 has been studied using any of the compounds discussed in this article. 6. Some of the double-blind studies reviewed are more than a decade old and techniques in research design have changed substantially since those studies were conducted. Many of the earlier studies would not be acceptable according to contemporary research design criteria because of inappropriate or inadequate inclusion criteria, inappropriate or inadequate outcome criteria, and inappropriate or inaccurate diagnostic criteria.(ABSTRACT TRUNCATED AT 400 WORDS)

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