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Biomedical subjects

D E Hartman

Publications and source records attributed to D E Hartman.

At least 19 recordsLinked to original sources

Downsizing, role demands, and job stress.

This is a cross-sectional study consisting of self-administered survey instruments to measure psychological distress and stress-inducing work demands after 6 months of rumors about an upcoming corporate downsizing event. The workforce consisted predominantly of white males who were married, college-educated, and nonsmokers. Higher stress levels were seen among older, more educated workers, who had longer company tenure. Role boundary problems, noxious physical environments, and company tenure were retained in the final multivariable model predicting distress level. The ongoing time delay for management to implement the threatened layoff and peer rankings for a new job performance appraisal contributed to a decline in worker solidarity because of concerns about career and job security. These uncertainties reduced worker productivity and effective teamwork.

Adult↗

Missed diagnoses and misdiagnoses of environmental toxicant exposure. The psychiatry of toxic exposure and multiple chemical sensitivity.

Toxins such as carbon monoxide, lead, and mercury that present occasionally with primarily psychiatric symptoms can pose some of the most difficult diagnoses. This article reviews the clues that can allow the diagnostician to identify the role of one of these substances. Equally important, the article discusses the contentious issues that surround the phenomen known as multiple chemical sensitivity. Viewed primarily as a functional illness, often with legal overtones, this putative disorder is critically reviewed to see if it meets the same demanding standard of validity that is found in the psychiatric symptoms associated with other toxic disorders. Although questioning the strict medical origin of medical chemical sensitivity, the article outlines some treatment hints that may helpful in the management of this difficult group of patients.

Adult↗

Stress among package truck drivers.

In 1992, a cross-sectional questionnaire study of package truck drivers in one company was conducted at four widely scattered sites throughout the US; 317 drivers participated, representing 82% of those eligible. The package truck drivers scored significantly above the US working population comparison norm on all summary and individual scales derived from the SCL 90-R, indicating a substantial increase in psychologic distress for this group. The Global Severity Index, the best single summary measure of psychological distress in the SCL 90-R, revealed a mean T score for the drivers of 64.20, 91st percentile of the normative population. The group perceived significantly more daily stressful events than the average working adult, and their sensitivity to these events was also increased. Role overload, a component of the Occupational Stress Inventory, was the most consistent factor associated with symptoms of psychological distress on multiple regression analysis. This study suggests that job stress is a psychological health hazard for these drivers.

Adult↗

Dysarthria associated with focal unilateral upper motor neuron lesion.

Speech motor changes in six patients with focal unilateral upper motor neuron (UUMN) lesions were characterised using a variety of techniques including listener judgements, speech acoustic analyses, electromyographic and strength measures. Listener judgements of speech understand-ability, intelligibility and dysarthric features indicated mild dysarthria. Diadochokinesis, electromyographic and strength measures corroborated these observations. The findings of this study delineate the characteristics of the dysarthria associated with unilateral upper motor neuron lesions and have important implications for identifying potential upper motor neuron components of other neurogenic disorders of speech and language.

Aged↗

A case of superior laryngeal nerve paresis and psychogenic dysphonia.

A psychogenic voice disorder co-occurred or evolved with the symptoms and signs of unilateral superior laryngeal nerve paresis. We speculated that the former was a manifestation of a musculoskeletal tension or conversion reaction disorder, whereas the latter was a sequela to a self-limiting inflammatory process. Voice therapy proved effective for alleviating the psychogenic dysphonia after the signs of the neuropathy had resolved, whereas psychotherapy offered strategies for stress management. A multidisciplinary approach to this patient provided for differential diagnosis and efficacious treatment.

Adult↗

Neuropsychology and the neurochemical lesion: evolution, applications and extensions.

The evolution of neuropsychology into a method for neurotoxic damage detection is reviewed. When neuropsychology is transformed into "neuropsychological toxicology", fundamental philosophical assumptions of the field are altered; the search for brain-behavior relationships must extend from structural damage into the analysis of neurochemical systems. The complementary relationship of human neuropsychology to basic toxicological and animal research is discussed. The great numbers of human "natural experiments" whose employment, medical history or substance abuse subjects them to contact with neurotoxic substances, suggest that there is a great need for expanded human investigations involving neuropsychological testing procedures in the service of research and clinical identification of neurotoxic syndromes. Further, it is argued that neurobehavioral procedures originally developed to detect industrial neurotoxic exposure will prove additionally useful assessing other brain-behavior disruptions mediated by neurochemistry or neurotoxicity rather than structural lesion. These frontiers include physical or emotional illness, substance abuse, effects of abused or prescription drugs as well as little-researched areas deserving of closer study, e.g., allergens or biotoxic exposure.

Behavior↗

Dysarthrias of movement disorders.

Following the seminal works of Canter (152) and Darley, et al. (1) concerning differential diagnosis and classification of dysarthria, considerable strides have been made with regard to characterizing the features of speech that occur with disorders of movement. Research should continue to address the neurophysiologic substrates of the dysarthrias of movement disorders, and most importantly, efficacious means of treating these impairments of speech.

Athetosis↗

Orofacial motor control impairment in Parkinson's disease.

Motor impairments in lip, jaw, and tongue muscles in patients with idiopathic Parkinson's disease (PD) were quantified. These orofacial muscle groups are nonuniformly endowed with muscle afferents, thus permitting evaluation of the hypothesis that certain PD motor symptoms are due to aberrations in muscle afferent function. Tongue muscles, devoid of stretch reflexes, were most impaired, while jaw-closing muscles, with numerous spindles and a monosynaptic stretch reflex, manifested the least impairment. Seemingly, PD motor impairments are independent of fusimotor or muscle afferent dysfunctions.

Facial Muscles↗

Cautions in alternate-form presentation of aural test material: Speech Sounds Perception Test.

86 college students were administered the standard Speech Sounds Perception Test and an alternate recording. Although reliability between the two recordings was moderate (r = .68) when the standard was given first, but only .36 when the alternate form was given first, differences in performance were consistent with differences in attack and decay found in voice-print tracings. Results suggest caution in using an alternate form of a neuro-psychological test, particularly one using auditory stimuli, until cross-validation confirms the reliability coefficient and the level of performance.

Adult↗

Dysgraphia after right hemisphere stroke.

Acquired dysgraphia has been described as a disorder of graphemic selection and spatial temporal disorganization which can exist in isolation or as a component of a broader language or cognitive syndrome. There is little agreement on the locus of writing centers, although select areas within the left hemisphere have been suggested. We describe a patient who had dysgraphia after a right hemispheric stroke. He had no demonstrable signs of limb apraxia or visual field deficit, and only subtle signs of language impairment other than the writing disturbance. Treatment emphasized progressively more complex writing tasks which included the following: (1) written responses to picture/word stimuli, (2) word and sentence dictation, and (3) self-generated sentences and functional writing tasks. At discharge from the hospital the patient's writing was within normal limits. Our findings were similar to those described for a patient with a left hemispheric stroke who was primarily dysgraphic. We conclude that our patient's dysgraphia was a component of a subtle aphasia as well as a spatial temporal disorganization disorder.

Aged↗

Spastic dysphonia and essential (voice) tremor treated with primidone.

Primidone has been reported to be effective in reducing tremor in patients with benign essential tremor. There is at least one report that suggests that the medication may reduce voice tremor, a frequent component of the essential tremor syndrome. Three patients with spastic dysphonia of essential (voice) tremor and one with more typical essential (voice) tremor were treated with primidone and experienced no alleviation in the voice signs. The side effects experienced by all patients were consistent with those noted in previous reports. Primidone does not seem to be effective in treating essential voice tremor or spastic dysphonia of essential voice tremor.

Aged↗

Psychogenic aphonia masking mutational falsetto.

Aphonia, originally due to laryngeal inflammation, became psychogenic and superimposed on the unstable pitch of adolescent voice change. We presumed that the aphonia was adopted as a means of dealing with peer pressure to maintain a high preadolescent pitch as well. Voice therapy was effective in alleviating both the aphonia and mutational falsetto. Clinicians should be alert to underlying mutational falsetto when confronted with an aphonic or dysphonic adolescent patient with no organic laryngeal pathologic condition.

Adolescent↗

A case of vocal cord nodules masking essential (voice) tremor.

Essential tremor is a progressive, potentially debilitating disorder that may be manifested in the voice only. In the case we report, the signs occurred concurrently with the voice characteristics of vocal cord nodules but were subtle. The mildness of the voice tremor precluded treatment at this time, although the results of medical management for the disorder have not been impressive. It is probable that some patients with severe essential (voice) tremor have undergone recurrent laryngeal nerve resection for the disorder.

Diagnosis, Differential↗