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Biomedical subjects

D T Blair

Publications and source records attributed to D T Blair.

9 recordsLinked to original sources
PubMed1992

Extrapyramidal symptoms are serious side-effects of antipsychotic and other drugs.

Antipsychotic medications commonly produce extrapyramidal symptoms as side effects. The extrapyramidal symptoms include acute dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome. Extrapyramidal symptoms are caused by dopamine blockade or depletion in the basal ganglia; this lack of dopamine often mimics idiopathic pathologies of the extrapyramidal system. Less recognized is that extrapyramidal symptoms are also associated with certain non-antipsychotic agents, including some antidepressants, lithium, various anticonvulsants, antiemetics and, rarely, oral-contraceptive agents. Extrapyramidal symptoms caused by these agents are indistinguishable from neuroleptic-induced extrapyramidal symptoms. Clinicians must be able to recognize these side effects and be able to determine the antipsychotic-induced and non-antipsychotic causes of extrapyramidal symptoms.

Antipsychotic Agents↗
PubMed1991

Assaultive behavior. Does provocation begin in the front office?

1. Provocation is an important risk predictor because these issues can be recognized, assessed, and appropriate interventions can be implemented to reduce the associated risks. It is only by the reduction of such "non-fixed" risk factors that any reduction of assaults can be accomplished. 2. Involuntary admission, patients with dementia or organic brain disorder, physical or verbal limits, staff attitude, denial of the possibility of assaults, and the educational level and clinical experience of the staff may help provoke an assaultive episode. 3. An important step is assessing the assault to identify provocation due to certain medical causes, and to document the extent of degeneration in patients with dementia or organic brain disorder. Medical intervention would be indicated and would appropriately address the causes of some violent episodes.

Aggression↗
PubMed1991

PTSD and the Vietnam veteran: the battle for treatment.

1. Patients with post-traumatic stress disorder (PTSD) often encounter treatment that is complicated by professional bias, personal issues, countertransference, and pathological staff dynamics. 2. Treatment is further complicated by diagnostic confusion, the dual diagnoses of substance abuse or depression, and symptoms that mimic personality disorders or psychosis. 3. The special circumstances of the Vietnam conflict that contributed to the susceptibility and etiology of PTSD are the individual characteristics of those who served, the special nature of the war itself and the military strategies used, and the psychosocial and cultural milieu in which it occurred.

Attitude of Health Personnel↗
PubMed1991

Assaultive behavior: know the risks.

1. Violence in our society is an increasing national concern, and violence in health-care settings reflects this trend. Assaultive episodes continue to increase in health-care settings due to various cultural, sociological, and political factors. 2. Present administrative and educational solutions to the problems of assault have failed to decrease the incidence and, in fact, may contribute to the increasing number of assaultive episodes. 3. Psychiatric staff can reduce incidence of assault by recognizing the risk factors and designing styles and interventions with these factors in mind. 4. Risks most often associated with assault are history of assault, diagnosis of dementia or organic brain disorder, intoxication from drugs or alcohol, and from the characteristics of the milieu and treatment itself.

Alcoholism↗
PubMed1990

Risk management for extrapyramidal symptoms.

Extrapyramidal symptoms (EPS), the side effects of antipsychotic medications, have become the focus of much attention from clinical researchers, the courts, consumer groups, and even the U.S. Congress. The major clinical manifestations of EPS, the etiology, symptoms, and treatments are reviewed. The literature identified risk factors for EPS--those specific to the patient, to the particular antipsychotic agent used, and to the nature of the ongoing treatment for EPS. By quantifying these factors, weighting them according to the known risks, a risk management tool is developed for use in predicting which patients are at higher risks for EPS, in evaluating treatment, and in assessing the responses of patients to changes in their condition and to the subsequent adjustments in treatment. The risk management tool provides guidelines for the continual evaluation of these changes, with the goal of minimizing the risks for EPS.

Aged↗
PubMed1990

Akathisia. When treatment creates a problem.

1. Akathisia is a state of restlessness and motor agitation, which includes subjective feelings of inner tension, emotional unease, anxiety, a constant need to move, restless motor activity, and an inability to tolerate inactivity or rest. 2. Akathisia is often unrecognized or misdiagnosed as agitation or anxiety of psychiatric origin; this often leads to inappropriate increases in the antipsychotic dosage, which then potentiates its severity, or to the misuse of antianxiety agents, which masks symptoms. 3. Akathisia can be easy to recognize by simple clinical observation of the patient's behaviors, especially if the symptoms worsen after increases in antipsychotic dosages or the frequent use of as needed medications. Assessment must also include the patient's own report.

Adult↗
PubMed1979

Fixed-bed uncoated charcoal hemoperfusion in the treatment of intoxications: animal and patient studies.

We examined the efficacy of a new, fixed-bed, uncoated charcoal device in experimentally intoxicated dogs and in drug-intoxicated as well as chemically poisoned patients. In the animal studies, 4 h of hemoperfusion resulted in a significant decrease in the blood level of phenobarbital, salicylate, pentobarbital and glutethimide. The drug clearances varied between 97 +/- 10 and 129 +/- 6 ml/min. However, the total amount of drug removed was higher for phenobarbital and salicylate which have a small apparent volume of distribution (AVD) than for pentobarbital and glutethimide which have an AVD greater than total body water. We next treated 14 patients suffering from a wide variety of intoxications. Patients intoxicated with phenobarbital, methsuximide, chlordane and Amanita muscaria all showed a significant improvement in their clinical status. Patients intoxicated with ethchlorvynol, glutethimide, methaqualone, podophyllin and fluoroacetamide did not improve. Charcoal hemoperfusion may be useful in patients poisoned with drugs characterized by an AVD smaller than total body water. No major complications were encountered during the hemoperfusions.

Adolescent↗