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Biomedical subjects

D S Schubert

Publications and source records attributed to D S Schubert.

At least 19 recordsLinked to original sources
PubMed1992

Physical consequences of depression in the stroke patient.

The past literature suggests the hypothesis that depression is associated with decreased physical functional ability in stroke patients. On a medical rehabilitation ward, 21 stroke patients were evaluated for depression by psychiatric interview and self-report, and were also rated on the Barthel's Functional Index (BFI). The hypothesis was supported: Patients scoring 17 or higher on the Beck Depression Inventory (BDI) (N = 7) had lower initial scores on the BFI than patients with lower BDI scores. There was a trend for these seven depressed patients to improve more slowly as ascertained by the BFI. Depression was suggested to lower functional ability by increasing fatigue, hopelessness, and decreasing motivation.

Activities of Daily Living↗
PubMed1992

Decrease of depression during stroke and amputation rehabilitation.

Clinical observation had suggested that mild depression occurs after admission for acute medical treatment and then decreases during further hospitalization for rehabilitation treatment. The Geriatric Depression Scale (GDS) was given on admission and discharge to 14 stroke and 17 amputee rehabilitation patients. Each of the two groups showed decreasing GDS scores from beginning to end of the rehabilitation admission. Suggested reasons included: (1) the gradually diminishing effects of stroke and amputation as life crises during the 1-2 month admission, (2) effects of physical improvement on mood and affect, (3) milieu effects of the medical ward, and (4) tendencies for all psychopathology scale scores to decrease on retest.

Activities of Daily Living↗
PubMed1992

Detection of depression in the stroke patient.

The literature suggests the hypothesis that nonpsychiatrists will underrecognize depression in evaluations of stroke patients. On a medical rehabilitation ward, 15 stroke patients were evaluated for depression by psychiatric interview and self-report. Charts were examined for detection of depression by the rehabilitation team. The hypothesis was supported: in contrast to psychiatric interview (68% depressed) and self-report (Beck Depression Inventory, 50% depressed), none of the patients were described as depressed in chart notes by the rehabilitation team (excluding the psychiatrists). Psychiatrists should develop ongoing interactions with primary care physicians to improve detection of poststroke depression and other depressions on medical wards.

Aged↗
PubMed1992

Increase of medical hospital length of stay by depression in stroke and amputation patients: a pilot study.

Past studies have found that medical patients with the diagnosis of depression (comorbidity) have longer hospital lengths of stay (LOS) than those without the diagnosis of depression. This suggested that scores on a depression scale would be positively correlated with LOS. On a rehabilitation ward, 14 stroke and 17 amputee patients were given the Geriatric Depression Scale (GDS) and lengths of stay were recorded. Correlations between GDS scores and LOS were +0.575 for stroke and +0.266 for amputee patients, both in the hypothesized direction. Explanations considered included: (1) depression and medical illness each produce morbidity which summate to require increased LOS; (2) depression delays medical recovery as well as the appearance of medical recovery, and (3) discharge planning is complicated by depression. When depression is associated with inpatient medical illness, DRGs may need to be reevaluated.

Activities of Daily Living↗
PubMed1991

Delirium after cessation of glucocorticoid therapy.

We report here a case of delirium that occurred after discontinuation of glucocorticoid therapy. Administration of hydrocortisone reversed the mental status changes seen in this patient. We review similar reported cases and discuss the direct actions of glucocorticoids on the brain.

Delirium↗
PubMed1990

The use of the MacAndrew Alcoholism Scale in detecting substance abuse and antisocial personality.

We evaluated the hypothesis that characterological factors, particularly antisocial personality, influence scores on the MacAndrew Alcoholism Scale (MAC). Using the Washington University research criteria to establish diagnoses, the following subgroups were defined: subjects who received no psychiatric diagnoses; subjects who received diagnoses other than alcoholism, drug dependence, or antisocial personality; and subjects who received a diagnosis of alcoholism, drug dependence, and/or antisocial personality, alone or in combination with other psychiatric diagnoses. The highest MAC scores were obtained by subjects diagnosed as having antisocial personality without alcoholism or drug dependence and subjects diagnosed with antisocial personality, drug dependence, and alcoholism. Alcoholics without antisocial personality or drug dependence, and subjects with other psychiatric diagnoses scored lowest. Although higher MAC scores were obtained by males, MAC scores greater than 24 correctly classified the greatest number of males and females as alcoholic, drug dependent and/or antisocial. These findings are interpreted as consistent with MacAndrew's reinterpretation of the scale as assessing a dimension of personality, rather than solely a tendency to addiction.

Adult↗
PubMed1989

Effect of liaison psychiatry on attitudes toward psychiatry, rate of consultation, and psychosocial documentation.

Prior literature suggested that psychiatric liaison on medical wards would produce a more positive attitude towards psychiatry, more psychosocial chart documentation, and a higher consultation request rate. Over 3 years, liaison was conducted on two medical wards, and its effect was contrasted with two control (consultation only) medical wards. Liaison activities were more favorably received by consultees than consultation alone and increased the consultation request rate, but produced no change in psychosocial documentation. Additional effectiveness of liaison activities might be achieved through direct, focused interventions, and through active involvement of senior medical faculty.

Attitude of Health Personnel↗
PubMed1989

Electroencephalographic changes and other indices of neurotoxicity with haloperidol-lithium therapy.

This prospective study was undertaken in order to establish indices of possible neurotoxicity due to the combination of lithium with haloperidol and a combination of lithium with other neuroleptics. Twenty-one subjects who were receiving neuroleptic-lithium combination were studied. Of them, 14 had a primary affective disorder-manic phase, and 7 had schizophrenia as judged by Feighner criteria. The subjects were evaluated on clinical, neuropsychological measures and EEG at baseline and 10-14 days after addition of lithium to the neuroleptic regimen. Of 11 subjects receiving the haloperidol-lithium combination, 5 (45.4%) showed abnormal responses on EEG. Of these 5 subjects, 3 showed abnormal photic responses, and 2 showed slowing in posterior alpha activity. These photoparoxysmal and photomyoclonic responses are indicative of cerebral pathophysiology resulting from the interactive effect of the haloperidol-lithium combination. The photic and other associated EEG abnormalities reported may be the earliest indication of neurotoxicity. No significant changes were observed in the EEG in 10 subjects treated with other neuroleptic-lithium combinations. In a statistical comparison the haloperidol-lithium combination had significantly more frequent EEG changes than the combination of lithium with other neuroleptics. This study presents sufficient evidence from reported photic and other associated EEG changes to pursue further investigation of neurotoxicity due to haloperidol-lithium therapy. Such a study should employ a larger number of subjects, random assignment of subjects to treatment and control groups, and blind evaluation of data.

Adult↗
PubMed1988

Reverse liaison rounds with a burn unit case.

A liaison rounds is presented, one attended by all members of a consultation-liaison (C-L) team along with the medical director of a burn unit. This structure is designated as a "reverse liaison rounds," as it is the opposite of the conventional liaison meeting, which consists of one C-L consultant and the total nonpsychiatric team. The content centered on a self-inflicted burn case in which countertransference issues involved a nonpsychiatrist. The unconventional format of the reverse liaison rounds provided all parties with new knowledge, perspectives, and insights into the interactions between the C-L consultant and the burn unit team.

Adult↗
PubMed1988

A statistical evaluation of the literature regarding the associations among alcoholism, drug abuse, and antisocial personality disorder.

Prior literature suggested an association among alcoholism, drug abuse, and antisocial personality disorder. A meta-analysis of inferential studies bearing on these associations was performed on 40 studies. Results demonstrated that each diagnosis in the triad had a significant positive association with each of the other two. Possible common etiologies of the diagnoses were discussed. Presence of one of the three diagnoses suggests that consideration of the other two is advisable. Finally, interrelationships among the diagnoses may explain treatment results common to several of the diagnoses.

Alcoholism↗
PubMed1986

Evaluation of studies on platelet alpha 2 adrenoreceptors in depressive illness.

Discrepant results have been reported from at least ten laboratories regarding the status of platelet alpha 2 adrenoreceptors in depressed patients. Using a statistical test to combine those studies which utilized radioligand binding techniques, we find the overall data support an elevation in density of platelet alpha 2 adrenoreceptors from drug-free depressed patients (p less than 0.05) and suggest a normalization to lower binding values following antidepressant drug treatment (0.05 less than p less than 0.10). However, these positive results are attributable to highly significant findings by only three laboratories. Much of the discrepancy may be attributable to numerous methodological variables which distinguish the studies. Foremost amongst these variables are the use of different platelet size populations, the use of different medium, and the choice of radioactive ligand and competitor (non-radioactive ligand) in the assay. We present a rationale for the proper choice of each methodological condition used in the clinical assessment of platelet alpha 2 adrenoreceptor status, hoping that improved experimental designs will resolve the current controversy.

Adrenergic alpha-Antagonists↗
PubMed1986

EEG observations during combined haloperidol-lithium treatment.

Some reports have indicated a neurotoxic interaction of haloperidol and lithium, whereas others have not found this interaction. This is a report on two patients who showed both photomyoclonic and photoparoxysmal responses while on combined lithium-haloperidol treatment. We suggest that these findings, which have not been previously reported to be associated with combined lithium-haloperidol treatment, reflect neurotoxicity and that electroencephalogram (EEG) monitoring should be done on patients receiving this combined medication regimen.

Adult↗
PubMed1979

A biphasic change in mood with a tricyclic antidepressant.

Eight depressed patients received 150 mg of clomipramine for 4 weeks. They completed the Profile of Mood States five to seven times the first week of treatment and five to seven times at the end of treatment. Moods showing significant decrease from the beginning to the end of the first week were: tension-anxiety, depression, anger-hostility, and confusion. The only changes from the beginning to the end of the 4-week period were an increase in vigor and a decrease in fatigue. The occurrence of rapid and slow mood changes with antidepressants suggested that the former were due to sedative effects and the latter occurred at the rate of the improvement in the disease depression.

Adjustment Disorders↗