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Biomedical subjects

G Fulop

Publications and source records attributed to G Fulop.

At least 37 records · Page 2Linked to original sources
PubMed1991

Diagnosis and treatment of psychiatric disorders in medically ill inpatients.

Medical and surgical inpatients with coexisting psychiatric disorders pose several challenges to the consulting mental health professional in the general hospital. A major challenge is determining whether presenting signs and symptoms have a medical or psychiatric basis. Making such a determination requires a careful history, a mental status examination, and the utilization of bedside screening and diagnostic instruments. Recommended treatments include psychotherapy, psycho-education, and pharmacotherapy. However, psychotropic drugs must be used with caution because of potential interactions with drugs prescribed for medical conditions. Studies indicate that timely psychosocial interventions can improve the medical patient's mental health and have the potential to reduce length of hospital stay and utilization of health services.

Comorbidity↗
PubMed1990

Presence of intestinal intraepithelial lymphocytes in mice with severe combined immunodeficiency disease.

The murine intestinal epithelium contains a heterogeneous population of intraepithelial leukocytes (IEL) most of which are granulated, Thy-1-CD5-CD8+. In order to assess the lineage relationship of this subgroup of IEL to peripheral T cells, we examined IEL in mice with the severe combined immunodeficiency (scid/scid) mutation, which lack T and B cells in peripheral lymphoid tissues. Electron and light microscopy showed that the intestine from scid/scid mice had granulated IEL similar to IEL in normal C.B-17 mice. Flow cytometry of isolated IEL stained with monoclonal antibodies against Thy-1, CD3, CD4, CD5 and CD8 showed that scid/scid mice IEL contained cells with the Thy-1-CD4-CD5-CD8+ phenotype. Immunohistochemical staining of IEL in tissue sections with antibodies to Thy-1 and CD8 confirmed that the Thy-1-CD8+ cells were in the intestinal epithelium. These scid/scid IEL also lacked CD3 expression and mRNA for the V gamma 7 V region gene of the gamma T cell receptor. We conclude that scid/scid mice contain precursors for IEL that can differentiate into a granulated Thy-1-CD5-CD8+ IEL in the intestine. The absence of CD8+ peripheral T cells in these mice suggests that these IEL differ from classical T cells in their ability to differentiate and express CD8 and do not require T cell receptor expression for their localization to the intestine.

Animals↗
PubMed1990

Follow-up of psychiatric comorbidity in the general hospital.

Although appropriate follow-up is an important task in the consultation setting, little attention has been directed to its frequency, or the risk profile for minimal or maximal follow-up. Eight hundred twenty-three patients from 1983 to 1986 were examined at the Mount Sinai Hospital using a computerized psychiatric consultation database that recorded demographic information, reason for referral, DSM-III 5 Axes diagnosis, recommendations and number of follow-up interviews. Forty-two percent of the consultations had three or less (minimum) follow-up visits. The minimum follow-up group were significantly less often referred for depression or diagnosed as depression (p = .01), had fewer psychosocial stressors (Axis III) (p = .03), and recommendations for psychosocial treatment by the psychiatric consultant (p = .0001), but had significantly more personality disorders (Axis II) (p = .04). Sixty-two percent of the consultation patients were correctly classified into the follow-up groups by the variables: 1) marital status; 2) living situation; 3) problem assessed as chronic illness or pain; 4) absence of an Axis I diagnosis or diagnostic uncertainty; and 5) number of recommendations by the consultant.

Chronic Disease↗
PubMed1990

Evaluation and treatment of mental disorders in patients with AIDS.

Mental symptoms are common in patients with AIDS. Optimal management involves the identification and treatment of underlying mental disorders rather than symptomatic treatment alone. Organic mental disorders are very frequent in AIDS, particularly with seriously ill patients who are medical inpatients. There is a high priori probability that such common symptoms as agitation, irritability, and insomnia will be caused by an organic mental disorder. Psychopharmacology in the patient with AIDS requires considerable caution. Lower doses and careful surveillance for subtle neuropsychiatric side effects are necessary. Routine medical contact with a compassionate physician may be of inestimable value to the patient in coping with the fear and dread that surround the illness.

AIDS Dementia Complex↗
PubMed1990

Anxiety disorders in the general hospital setting.

Using the 1987 National Hospital Discharge Survey database, one percent of adult medical/surgical inpatients with a principal medical or surgical diagnosis were found to have a concurrent anxiety disorder. The anxiety comorbidity inpatients were older, more likely to be white, female, and unmarried compared to others (inpatients without anxiety noted on the discharge summary). In addition to an anxiety disorder, 7% had a substance use disorder, and 5% had a major affective disorder. Anxiety comorbidity inpatients stayed longer in the hospital than other inpatients: mean (SD) 7.1 (9.4) vs 6.3 (8.6) days. Anxiety comorbidity inpatients were less likely to die in the hospital, and were more likely to leave the hospital against medical advice than other inpatients. Medical/surgical inpatients received less diagnoses of anxiety disorders than predicted by surveys of community-dwelling individuals (7.3%) or by anxiety symptom screens among medical inpatients (20-25%). The difference may be explained by under-reporting, under-recognition, or the rationalization by physicians that anxiety is an expected part of an acute medical hospital stay. The inpatients receiving an anxiety diagnosis may represent the most severely affected individuals, whose anxiety most significantly affected the hospital course. Since timely psychosocial intervention has been shown to reduce hospital stay, a psychiatric consultation may have the added benefit of shortening stays and cutting costs, while improving the quality of care received by medical and surgical inpatients with anxiety disorders in the general hospital setting.

Adult↗
PubMed1989

A model of human acute lymphoblastic leukemia in immune-deficient SCID mice.

A human acute lymphoblastic leukemia (ALL) cell line that was transplanted into immune-deficient SCID mice proliferated in the hematopoietic tissues, invaded various organs, and led to the death of the mice. The distribution of leukemic cells in SCID mice was similar to the course of the disease in children. A-1 cells marked with a retrovirus vector showed clonal evolution after the transplant. SCID mice that were injected with bone marrow from three patients with non-T ALL had leukemic cells in their bone marrow and spleen. This in vivo model of human leukemia is an approach to understanding leukemic growth and progression and is a novel system for testing new treatment strategies.

Animals↗
PubMed1989

Controlled study of haloperidol, pimozide and placebo for the treatment of Gilles de la Tourette's syndrome.

The results of this controlled study of the treatment of 57 patients with Gilles de la Tourette's syndrome suggested that both haloperidol and pimozide were more effective than placebo, but that haloperidol was slightly more effective than pimozide. Adverse effects occurred more frequently with haloperidol vs placebo than with pimozide vs placebo, but the frequency was not significantly different for haloperidol compared with pimozide. Clinically significant cardiac effects did not occur at a maximum dosage of 0.3 mg/kg or 20 mg/d for pimozide and 10 mg/d for haloperidol. However, the QTc interval was prolonged during pimozide treatment compared with that during haloperidol treatment, although the values for both medications were not in an abnormal range.

Adolescent↗
PubMed1989

Psychiatric consultation on an otolaryngology liaison service.

Otolaryngology patients (especially those with tracheostomies) present a significant challenge to psychiatrists from both a diagnostic and therapeutic standpoint. To date, no study has been made of psychiatric disorders among this important group of patients. At the Mount Sinai Medical Center, a liaison psychiatrist has been involved with a specialized otolaryngology cluster unit since 1979. Using a 384-item computerized database protocol developed at Mount Sinai, data on 139 otolaryngology patients were recorded and compared with 1662 "Other" inpatient psychiatric consultations on the medical and surgical services during 1980-1987. The otolaryngology patients as a group were more likely to be male (p = 0.011), married (p = 0.001) and employed (p less than 0.001). Cancer was the most common medical disorder, and the average level of stress as reported on DSM-III's Axis IV (5.1, severe) was significantly greater (p less than 0.0001) than that for the "Other." The most common psychiatric response was adjustment disorder (36%). The length of stay of those ENT patients seen in psychiatric consultation was 26.4 days, in contrast to 11.1 days for all ENT patients. However, the length of stay of those patients on ENT receiving a psychiatric consultation was not different from the "Other" psychiatric consultation cohort (26.3 days). Despite the higher level of stress, the incidence of significant psychiatric morbidity was lower for the ENT cohort. The primary effect of the liaison psychiatrist was to lower the threshold for case identification that enhanced the referral rate on the ENT unit.

Adaptation, Psychological↗
PubMed1989

Consultation--liaison psychiatry. Possibilities for the 1990s.

In order for consultation-liaison (C/L) psychiatry to enhance its acceptance and funding, carefully designed outcome studies that will demonstrate its clinical effectiveness to other disciplines in medicine, departments of psychiatry, hospital administration, third-party payors, and patients are required. The development of alternative methods of funding C/L services is described: (1) high-risk screening, renal transplant, geriatric units (Medicare); (2) salary stipends from collaborating disciplines, e.g., medicine, ENT, neoplastics; (3) consultation fees; (4) ambulatory C/L clinics (Medicaid); and (5) grants from collaborative research. With a change in structure when it can be employed (from consultation to the screen methodology), the development of scientifically derived outcome data of C/L psychiatry interventions, adequate documentation of the evaluation and treatment by C/L psychiatry, and the new tools biological psychiatry and psychopharmacology will provide, the 1990s could and should be an exciting time for this subspecialty of psychiatry.

Forecasting↗
PubMed1989

Reliability, validity, and temporal stability of the geriatric depression scale in hospitalized elderly.

The reliability, validity, and temporal stability of the Geriatric Depression Scale (GDS) were studied in sixty-nine elderly patients who had their broken hips surgically repaired. The GDS demonstrated internal consistency reliability and concurrent validity with the Hamilton Depression Rating Scale. In addition, the GDS was stable across the hospital stay and thus appeared to be less influenced by the patients' acute health status.

Aged↗
PubMed1988

Screening devices for diminished cognitive capacity.

This study compares three commonly used tests to detect organic mental disorders: the Mini-Mental State (MMS), Cognitive Capacity Screening Examination (CCSE), and Tachistoscope (T-Scope). Ninety-seven medical-surgical inpatients at the Mount Sinai Hospital referred for psychiatric consultation had a Missouri Mental Status Examination performed by a psychiatrist who also rated the patients' organic mental disorder as "none," "mild," "moderate," or "severe." The CCSE, MMS, and T-Scope, respectively, showed: sensitivity--0.54, 0.52, 0.68; specificity--0.85, 0.76, 0.79; and positive predictive value--0.83, 0.74, 0.79. False negatives occurred more often among those patients with mild organic mental disorders with all instruments (p = 0.05), while the T-Scope could not be administered in 27% of the patients. Screening instruments with increased acceptability, sensitivity, and specificity need to be developed to identify a potentially life-threatening disorder.

Adult↗
PubMed1988

Disulfiram use at hospital-based and free-standing alcoholism treatment centers.

Disulfiram (Antabuse) is one method for treating alcoholism, despite controversy over its clinical effectiveness. This study examines the hypothesis that hospital-based alcoholism treatment centers would use disulfiram more frequently than free-standing centers in the New York City metropolitan area. A large variation in percentage of patients receiving disulfiram was observed (0%-97%) in both settings. The use of disulfiram at hospital-based centers (27%) was not statistically different from that at free-standing centers (34%). Demography, alternate types of alcoholism treatment offered, and number of physicians on staff did not significantly affect disulfiram use. Personal views of disulfiram by the program director or treating physician were more important determinants of disulfiram use than type of treatment facility. Further study of factors influencing the use of disulfiram by type of alcoholism center may facilitate appropriate referral of patients who may benefit from disulfiram treatment.

Alcoholism↗
PubMed1988

Tear urea nitrogen and creatinine levels in renal patients.

Tear and blood urea nitrogen, creatinine, and glucose levels were quantitatively analyzed by an enzymatic method in 30 normal patients and in 10 patients with end stage renal disease. The tear and blood samples collected from the end stage renal patients before and after hemodialysis showed that the change in urea nitrogen and creatinine levels in the tears correlated with the change in blood urea nitrogen and creatinine. Tear samples may serve as an alternative, less invasive indicator of serum metabolites in renal patients.

Adolescent↗