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Biomedical subjects

E A Burch

Publications and source records attributed to E A Burch.

34 records · Page 2Linked to original sources
PubMed1985

Diagnostic limitations of the dexamethasone suppression test in screening for depression.

Research advancements in the use of laboratory testing to diagnose psychiatric conditions have recently led to certain misconceptions about the diagnostic accuracy of these tests. One such test, the dexamethasone suppression test (DST), was introduced as a laboratory test for melancholia (or "endogenous" depression). Because depressed patients are frequently first seen as outpatients by primary care physicians, there has been interest in using the DST as a screening test for depression. This paper lists the variables that contribute to abnormal (false-positive?) DST results and points out the diagnostic limitations of this laboratory test in outpatients. Several guidelines are proposed for diagnosing depression without the DST.

Ambulatory Care↗
PubMed1983

Loxapine in the treatment of psychotic-depressive disorders: Measurement of antidepressant metabolites.

Psychotic patients who also have endogenous depressive symptoms often require treatment with several drugs (usually a neuroleptic-antidepressant combination) or electroconvulsive therapy. Loxapine is a neuroleptic of the dibenzoxazepine class; it is metabolized in vivo to desmethylloxapine (amoxapine) and 8-hydroxyamoxapine, two compounds with antidepressant activity. We traced the serum levels of total amoxapine (amoxapine plus 8-hydroxyamoxapine) in two treatment-resistant patients with psychotic-depression syndromes. One patient was treated with loxapine alone and the other with a loxapine-amoxapine combination. We also determined the total loxapine and amoxapine serum levels of ten patients treated at various dosages of loxapine alone. The results demonstrate that many patients treated with loxapine attain substantial serum levels of total amoxapine, some in concentrations thought to be therapeutic for nonpsychotic endogenous depression. We recommend further studies to determine the efficacy of loxapine in the management of treatment-resistant patients with psychotic-depression syndromes.

Adult↗
PubMed1983

Depot pipotiazine 1970-1982: a review.

In the past 14 years pipotiazine palmitate, the second oldest depot neuroleptic, has proven to be effective and safe in reducing and preventing resurgence of symptoms of acute and chronic psychoses, chiefly in schizophrenia. It is particularly valuable in the management of erratic ingestors and unreliable absorbers of oral neuroleptics. Clinical experience substantiates that pipotiazine palmitate therapy is best initiated at low doses (25 mg), and that the most effective maintenance dosage is 25 to 200 mg once a month. Pipotiazine palmitate has a low propensity to evoke extrapyramidal reactions; in fact, it causes the lowest incidence of EPS of all depot neuroleptics. Patients receiving pipotiazine palmitate seldom require concomitant antiparkinsonian medication. This review highlights other assets and liabilities of depot pipotiazine therapy.

Adolescent↗
PubMed1979

The congestive heart failure model of schizophrenia.

Many primary care physicians wish to address the psychiatric aspects of their medically ill patients but are impatient with the abstract terminology used in psychiatry's past psychoanalytical period. Modern psychiatry is a more integrated field and considers the biological and social as well as the analytical contributors to disease. Using these newer concepts, we present a teaching model in which schizophrenia is viewed as a syndrome and is compared with the well-known medical syndrome of congestive heart failure. This approach facilitates the conceptualization of a complex psychiatric illness and makes it more appealing to primary care physicians by demonstrating common gound between medicine and psychiatry.

Attitude of Health Personnel↗
PubMed1978

Hysterical symptoms masking brain stem glioma.

To function effectively as primary care specialists, psychiatrists must remain ever alert to the possibility of organic disorders in patients who at first show only psychiatric symptoms. A case is presented in which hysterical overlay led to misdiagnosis in a 31 year woman, who dies of a diffuse medullary glioma 3 1/2 years after onset of "conversion" symptoms. The authors point out how the label "hysterical" clouds longitudinal objective diagnostic observations especially when initial clinical and laboratory data fail to support a definitive organic diagnosis.

Adult↗
PubMedDate not supplied

Depression in the elderly: a beta-adrenergic receptor dysfunction?

Depression is a significant problem in the elderly population and is often accompanied by cognitive changes and agitation. Hypothalamic-pituitary axis dysfunction may occur in some depressed elderly patients and represent a non-specific physiological hyperarousal state. Moreover, recent evidence confirms that antidepressants down-regulate beta-adrenergic receptors in the central nervous system. These findings provide the background for proposing that depression may result from an age-specific, stress-induced dysfunction of the beta-adrenergic receptor system in a subgroup of the geriatric population. A bio-psycho-social model for understanding and developing innovative treatment strategies for depression in the elderly is presented.

Adaptation, Physiological↗