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Biomedical subjects

D A Fishbain

Publications and source records attributed to D A Fishbain.

106 records · Page 6Linked to original sources

Priapism resulting from fluphenazine hydrochloride treatment reversed by diphenhydramine.

A chronic schizophrenic patient received 30 mg fluphenazine hydrochloride (Prolixin) PO and developed priapism. Urological examination and subsequent urological workup was negative, indentifying fluphenazine hydrochloride as the cause of the priapism. During the period of priapism evaluation, the patient developed a severe extrapyramidal reaction that was treated with diphenhydramine (Benadryl) 50 mg IV push. There was remission of the extrapyramidal reaction in three minutes followed by resolution of the priapism. The rationale for the treatment of antipsychotic drug-induced priapism with anticholinergic drugs is discussed.

Adult↗

Suicide pacts: international comparisons.

Twenty suicide pacts (double suicides) from the Florida Dade County Medical Examiner's Office were identified. These data were compared using a standardized instrument to published suicide pact data from England, Japan, and Bangalore City, India. Results were analyzed using simple statistical methods. Major differences were found between Western suicide pacts and Eastern suicide pacts. In this study, the frequency of suicide pacts was found to be greatest for Japan; lover pacts were found to be typical for Japan; spouse pacts were typical for Dade County and England; and friend pact frequency was greatest for Bangalore City. In addition, it was found that suicide pact victims, in general, choose nonviolent suicide methods.

Adult↗

Cocaine-induced psychosis and sudden death in recreational cocaine users.

Fatal cocaine intoxication presenting as an excited delirium is described in seven recreational cocaine users. Symptoms began with the acute onset of an intense paranoia, followed by bizarre and violent behavior necessitating forcible restraint. The symptoms were frequently accompanied by unexpected strength and hyperthermia. Fatal respiratory collapse occurred suddenly and without warning, generally within a few minutes to an hour after the victim was restrained. Five of the seven died while in police custody. Blood concentration of cocaine averaged 0.6 mg/L, about ten times lower than that seen in fatal cocaine overdoses. Police, rescue personnel, and emergency room physicians should be aware that excited delirium may be the result of a potentially fatal cocaine intoxication; its appearance should prompt immediate transport of the victim to a medical facility. Continuous monitoring, administration of appropriate cocaine antagonists, and respiratory support will hopefully avert a fatal outcome.

Adult↗

Double suicides.

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Adult↗

Female homicide-suicide perpetrators: a controlled study.

The record files of the Dade County Medical Examiner Department were reviewed and 133 homicide-suicides were identified. Of these, ten (or 7.5%) were female perpetrated. The chart data of these 10 female homicide-suicide perpetrators, chart data of 50 female homicide-suicide victims, and 50 female individual suicides systematically selected as controls were tabulated using a standardized instrument. The results were analyzed for differences using simple statistical methods. The comparisons revealed that female homicide-suicide perpetrators were more likely than female homicide-suicide victims to live in mobile homes, kill their lover or ex-lover, have their crime accidentally discovered, leave a suicide note, kill on a weekend, and be depressed, but are less likely than female homicide-suicide victims to live with a spouse. Additionally, female homicide-suicide perpetrators were more likely than individual female suicides to live in mobile homes but less likely to live alone and to be depressed.

Depressive Disorder↗

A controlled study of suicide pacts.

The records of the Dade County Medical Examiner's Office were reviewed and 20 suicide pacts (double suicides) were identified. These 40 suicide pact victims were compared using a standardized instrument to 120 randomly selected single Dade County suicides, from the same time period and area. Suicide pacts were also compared based on their composition (spouses, other intrafamilial pairs, and lovers). Suicide pact victims differed significantly from single suicides on several variables, including the tendency to use guns, leave suicide notes, have alcohol-positive blood, be older, be less depressed, and to suicide in the morning hours.

Age Factors↗

Pain insensitivity in psychosis.

Three cases of psychosis associated with pain insensitivity are reported. Two patients were diagnosed as schizophrenic, while one patient was diagnosed as manic. In each case, because of pain insensitivity, the underlying medical condition was not apparent. These cases resulted in a diagnostic pitfall, death, and a medicolegal suit. The patient who died was given haloperidol, a drug that may have analgesic activity. Pain complaints of manic and schizophrenic patients should be evaluated with great care.

Adult↗

Cocaine intoxication, delirium, and death in a body packer.

The authors described a case of emergency department of presentation of acute cocaine delirium in a cocaine "body packer," ie, an individual who attempted to smuggle cocaine by intracorporeal means. Treatment for cocaine intoxication was not initiated because of patient gave a false history; did not present with seizures, stupor or coma; had no deterioration in vital signs until late in the presentation; and presented with apparent psychiatric symptomatology, ie, delirium. Delirium should be treated by first identifying its cause and by attempting to remove the cause by appropriate medical and surgical techniques.

Adult↗

Manic-depressive illness associated with Turner's syndrome mosaicism.

This case report describes a patient suffering from both manic-depressive illness and Turner's syndrome mosaicism. This is the second such patient to be reported, but the first to be described in detail and to receive full karyotypic analysis. The significance of the association of manic-depressive illness and Turner's syndrome for the analysis of the genetic transmission of manic-depressive illness is discussed.

Adult↗

Exclusive adult lesbianism associated with Turner's syndrome mosaicism.

A case of exclusive adult lesbianism and manic-depressive illness associated with Turner's syndrome mosaicism is reported. Turner's syndrome women are described as hyperfeminine without problems in gender identity, gender role, or arousal pattern. Adult lesbianism has never previously been reported in these women. The significance of lesbianism in association with Turner's syndrome mosaicism is discussed.

Adult↗

Detection of a "faked" strength task effort in volunteers using a computerized exercise testing system.

The objective of this study was to develop an experimental method to separate a "faked" strength effort from a "best" effort in volunteers. Thirty-four pain-free volunteers (18 males, 16 females) performed a shoulder press and pull-down on an isokinetic computerized exercise testing system (CETS), giving a best effort followed by a faked effort. Two months later, a randomly selected subgroup (6 males) repeated the experiment to test the predictive validity of the derived variables. In the statistical analysis, best efforts were first compared with fake efforts by paired ttest for 80 CETS variables for males and females separately. Variables showing a strong difference between the best and faked effort were then selected for further analysis. In the second step of the analysis, the method of multiple correlations (r2 method) was used to reduce the number of redundant CETS variables to five in both the male and female groups. In the third step, a stepwise discriminant analysis was used to select predictor variables for the male and female groups. For the variables selected by the discriminant analysis for both males and females, sensitivities and specificities were calculated. Finally, the developed discriminant formula was used in the predictive validity part of the study to determine the sensitivities and specificities of the developed method. The discriminant analysis selected the following CETS variables for male and female groups, respectively: duty cycle down, work weight/down, peak value up (males); and average power up, 40% repetition down, duty cycle up (females). For males, using their three variables, the discriminant function classified 77.14% of the efforts correctly with 88.9% sensitivity and 64.7% specificity. For females, using their three variables, the discriminant function classified 90.63% of the efforts correctly with 100% sensitivity and 81.3% specificity. In the predictive validity group, the discriminant function classified 75% of the efforts correctly with 83.3% sensitivity and 66.7% specificity. This pilot study indicates that the method developed here may be useful in the experimental study for the discrimination between faked and best efforts on this isokinetic CETS machine. Future studies using this method will need to involve a larger number of volunteers.

Adult↗

Do antidepressants have an analgesic effect in psychogenic pain and somatoform pain disorder? A meta-analysis.

OBJECTIVE: A significant amount of evidence indicates that some antidepressants have an analgesic effect. We wished to determine whether this analgesic effect could be demonstrated in studies that had used antidepressants for the treatment of pain in patients diagnosed with psychogenic pain or somatoform pain disorder. Meta-analysis was used for this purpose. METHODS: All randomized, placebo-controlled antidepressant treatment studies of patients diagnosed with psychogenic pain disorder or somatoform pain disorder were isolated. These studies were reviewed and relevant statistics were coded. For each study, a single p value for the drug/placebo comparison was found or calculated for pain change scores from pretreatment to completion of treatment. The z scores and effect sizes were calculated for each study, followed by a calculation of an overall z score and effect size. RESULTS: Eleven studies fulfilled the inclusion and exclusion criteria for this meta-analysis. The combined difference showed that antidepressants decreased pain intensity in patients with psychogenic pain or somatoform pain disorder significantly more than placebo (z = 5.71, p<.0001). The overall effect size was large (mean = 0.48) and ranged from 0 to 0.91. CONCLUSIONS: The results indicate that, in patients diagnosed with psychogenic pain or somatoform pain disorder, antidepressant treatment resulted in a reduction in pain that was significantly greater than that of placebo. Possible explanations for these results are discussed.

Analgesics↗

Capgras syndrome associated with metrizamide myelography.

A case of Capgras' Syndrome secondary to an Organic Mental Disorder associated with metrizamide myelography is presented. The relationship of Capgras' symptom to reduplicative paramnesia and prosopagnosia is discussed.

Aged↗