Biomedical subjects
G B Murray
Publications and source records attributed to G B Murray.
Electroconvulsive therapy for post-stroke depressed geriatric patients.
Medical records were retrospectively reviewed for 20 medically ill geriatric patients who received electroconvulsive therapy (ECT) for post-stroke depression from January 1982 to January 1991 at Massachusetts General Hospital. Of the 19 patients (95%) who improved with ECT, 7 patients (37%) suffered relapses despite maintenance anti-depressant medications. Relapses typically developed approximately 4 months after ECT. Five patients (23%) developed ECT-related medical complications. Three patients (15%) developed transient interictal confusion or amnesia. No patient experienced an exacerbation of preexisting neurologic deficits. These findings indicate that ECT is a generally well tolerated and effective treatment for depressed, medically ill post-stroke geriatric patients.
Psychostimulants for secondary depression in medical illness.
The hospital charts of 198 patients with acute medical or surgical illnesses who had been treated with either dextroamphetamine or methylphenidate for secondary depression during a 5-year period at the Massachusetts General Hospital were examined. Eighty-two percent of patients showed improvement following psychostimulant treatment. Seventy percent of all patients demonstrated marked or moderate improvement in depressive symptoms. No significant differences in efficacy between the two psychostimulants or across diagnostic categories for depression were observed. Patients improved quickly, usually within the first 2 days of treatment. Adverse reactions necessitating the termination of psychostimulant treatment occurred in 10% of trials. Anorexia was not observed as a side effect of treatment.
High-dose intravenous haloperidol for agitated delirium in a cardiac patient on intra-aortic balloon pump.
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Carbamazepine-induced thrombocytopenia.
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Pancreatic encephalopathy.
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Visual hallucinations on low dose amitriptyline.
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Exacerbation by dextroamphetamine of spasticity in a patient with motor neuron disease.
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Controlled study of extrapyramidal reactions in the management of delirious, medically ill patients: intravenous haloperidol versus intravenous haloperidol plus benzodiazepines.
In a prospective study, the intensity of extrapyramidal symptoms (EPS) was rated in two groups of delirious, medically ill patients. Fourteen patients received intravenous (IV) haloperidol and benzodiazepines for control of severe agitation and four received IV haloperidol alone. Patients were rated daily by a standardized scale for EPS by raters blind to the dose of haloperidol and benzodiazepines. Patients receiving haloperidol and benzodiazepines had significantly (p less than 0.001) less EPS than patients receiving IV haloperidol alone. In the haloperidol and benzodiazepine group there were only one case of very mild parkinsonian-like EPS and no cases of akathisia or dystonia. No adverse respiratory or cardiac reactions were seen in any patients. The literature on the use of IV haloperidol alone and in combination with benzodiazepines is briefly reviewed and possible explanations of the lower intensity of EPS with IV haloperidol in combination with benzodiazepines are discussed.
Psychiatric presentation of meperidine toxicity.
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Decreased extrapyramidal symptoms with intravenous haloperidol.
In a preliminary, prospective study, the intensity of extrapyramidal symptoms was rated in four patients receiving intravenous haloperidol and six patients receiving oral haloperidol. The raters were blind to the route of administration. In this pilot study, the first systematic evaluation of intravenous haloperidol and extrapyramidal symptoms, the patients receiving intravenous haloperidol experienced significantly (p less than .01) less intense extrapyramidal symptoms than did the patients receiving oral haloperidol. The literature on intravenous haloperidol is briefly reviewed, and possible explanations of the lower intensity of extrapyramidal symptoms with intravenous haloperidol in the patients studied are discussed.
On panic attacks and neurologic problems.
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Electroconvulsive therapy for poststroke depression.
Of the 193 patients with stroke and depression treated at Massachusetts General Hospital from 1969 to 1981, 14 had electroconvulsive therapy (ECT) for poststroke depression. Among these 14 patients, depression developed less than 1 year after stroke in 9 and more than 1 year after stroke in 5. Except for 2 of the patients in whom depression developed within a year, all had marked improvement in depression after ECT. A transitory cardiac arrhythmia developed in 1 patient, but none of the patients had an exacerbation of stroke or a worsening of neurologic status. These findings indicate that ECT is safe and effective for poststroke depression.
Clorazepate in the treatment of complex partial seizures with psychic symptomatology.
Clorazepate frequently can control symptoms in complex partial seizure disorders with psychic symptomatology at dosages less than those recommended for its use as an adjunctive anticonvulsant. Four case examples illustrate this use. These beneficial effects may reflect a heightened response by limbic seizure foci to the anticonvulsant effects of nordiazepam, or a potentiation of its anticonvulsant effects through attenuating patient anxiety.
Psychosis and water intoxication.
Three cases of psychosis, polydipsia, and water intoxication are presented as examples of a syndrome that is potentially unrecognized in psychiatric settings. Diagnostic and etiologic considerations, with particular attention to the syndrome of inappropriate antidiuretic hormone secretion (SIADH), are discussed through a review of relevant literature. A schema for a routine psychiatric evaluation is described that will minimize overlooking this association of psychosis and disturbed water balance.
Psychiatric presentation of epilepsia cursiva.
Coarse brain disease can first present as a behavioural or psychiatric disorder. Partial seizures with complex symptomatology (psychomotor or temporal lobe epilepsy) may offer particular difficulties in differential diagnosis from the "functional psychoses". The authors report a case of "running epilepsy" (epilepsia cursiva), that first presented as a behavioural problem, and review the literature on this rare form of psychomotor epilepsy.
Diazepam withdrawal: a current problem in recognition.
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