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Biomedical subjects

J C Markowitz

Publications and source records attributed to J C Markowitz.

At least 55 records · Page 3Linked to original sources
PubMed1994

Cardiovascular morbidity in high-risk patients during ECT.

OBJECTIVE: Cardiovascular events are the principal cause of medical morbidity in patients receiving ECT. To assess the risks of ECT for individuals with preexisting cardiovascular disease, the authors examined medical complications in older patients treated with ECT during a 1-year period. METHOD: A case-control design was used in a review of the charts of 80 consecutive patients who received ECT from August 1990 to August 1991. On the basis of accepted clinical criteria, patients over 50 years of age were divided into two groups: one at increased risk for cardiac complications (N = 26) and one at standard cardiac risk (N = 27). Outcome was measured with a scale designed to assess clinically relevant medical complications. RESULTS: The risk group was older and had received more medical consultations before ECT than the nonrisk group. Although patients in the risk group were more likely to develop minor complications during ECT, they did not differ significantly from the comparison group in the rate of major complications. No patients died or sustained permanent cardiac morbidity during ECT. CONCLUSIONS: In contrast to a similar study at the same site 15 years earlier, the current study found ECT to be relatively safe in an unselected study group of elderly patients with preexisting cardiac risk factors. The findings underscore the advances in ECT technique over the past 15 years and the importance of identifying and carefully managing patients with cardiac risk factors before and during ECT.

Adult↗
PubMed1994

Psychotherapy of dysthymia.

OBJECTIVE: The author reviews empirical research on the psychotherapy of dysthymia. Dysthymia, a prevalent mood disorder, has been shown frequently to respond to antidepressant medication. The need for a treatment for dysthymic subjects unable or unwilling to take, or unresponsive to, medication still remains. METHODS: Studies were located by computerized search and the author's knowledge of the literature. All reports of studies on psychotherapy outcome for dysthymic patients, except studies of late-life chronic major depression, were included. RESULTS: Psychotherapy research on dysthymia has been confined to small, usually uncontrolled studies with varying methods and limited follow-up. Cognitive approaches have been most frequently studied; the results have not been dramatic but do suggest that some dysthymic patients respond to brief cognitive therapies. Preliminary results of an ongoing study of interpersonal psychotherapy are promising. CONCLUSIONS: Given the public health importance of dysthymia and the availability of treatments, the time is ripe for clinical trials of antidysthymic psychotherapy. The author proposes the following guidelines for such trials: time-limited, manual-based psychotherapy, interpersonal focus, serial design, continuation and maintenance treatment, combined treatments, and follow-up assessments.

Adult↗
PubMed1993

An empirical study of defense mechanisms in dysthymia.

OBJECTIVE: The psychodynamic approach to understanding dysthymia has rarely been empirically tested. In this pilot study the Defense Mechanism Rating Scales were used to examine psychodynamic data from patients with dysthymia and patients with panic disorder in order to test the hypotheses that 1) dysthymic patients would be similar to panic patients in endorsing primarily lower-maturity defense mechanisms, 2) dysthymic patients would use a distinct pattern of defense mechanisms, different from that of panic patients, and 3) dysthymic patients would endorse more frequently than panic patients four individual defenses that tend to handle anger and low self-esteem poorly: devaluation, passive aggression, projection, and hypochondriasis. METHOD: Twenty-two subjects meeting the DSM-III-R criteria for primary early-onset dysthymia and 22 subjects meeting the DSM-III-R criteria for primary panic disorder were interviewed on videotape and rated on the Defense Mechanism Rating Scales. RESULTS: The dysthymic subjects scored significantly higher on narcissistic, disavowal, and action defense levels and on the four individual defenses of devaluation, projection, passive aggression, and hypochondriasis, as predicted, as well as on two additional defenses, acting out and projective identification. Both groups tended to use lower-maturity defense mechanisms. CONCLUSIONS: The defense mechanism profile identified for dysthymia differs from that for panic disorder and supports particular psychodynamic hypotheses about chronic depression. It could be useful in devising treatment strategies and as a measure of treatment efficacy.

Acting Out↗
PubMed1992

Prevalence and comorbidity of dysthymic disorder among psychiatric outpatients.

We investigated prevalence and comorbidity of DSM-III dysthymic disorder in a psychiatric outpatient clinic. Seventy-five consecutive outpatients received structured interviews. Prevalence of dysthymic disorder was 36% in the consecutive sample. Thirty-four dysthymic and 56 non-dysthymic patients were compared for comorbidity. Dysthymic subjects were more likely to meet criteria for major depression, social phobia, and avoidant, self-defeating, dependent, and borderline personality disorders. Dysthymic disorder was usually of early onset, predating comorbid disorders, and had often not received adequate antidepressant treatment. These results help define dysthymic disorder as prevalent, usually predating axis I comorbidity, and associated with particular axis II diagnoses.

Adult↗
PubMed1992

Interpersonal psychotherapy of depressed HIV-positive outpatients.

In an open pilot study, 23 depressed adults infected with human immunodeficiency virus were treated using interpersonal therapy. Twenty subjects recovered from depression after a mean of 16 sessions. The authors discuss six aspects of interpersonal therapy that make it useful with depressed HIV-infected persons: psychoeducation about the sick role; a here-and-now framework; formulation of problems from an interpersonal perspective; exploration of options for changing dysfunctional behavior patterns; identification of focused interpersonal problem areas (grief, role transition, interpersonal disputes, and interpersonal deficits); and the confidence therapists gain from a systematic approach to problem formulation and treatment. Results suggest that mental health professionals should consider interpersonal therapy as a treatment for depressed HIV-positive patients.

AIDS-Related Opportunistic Infections↗
PubMed1990

The future of psychiatry.

Psychiatry is rapidly changing. The authors review the history of psychiatry in the United States, its gradual integration into medicine and society, and the dialectic between its "biologic" and "mentalist" outlooks. After describing the current state of the profession and its knowledge base, they discuss the likely future of the field: psychiatry's projected mode of practice and economics; its future as a science for understanding human behavior; its expected boundaries with other treatment disciplines; its anticipated relationship with academia and with the community at large; and internal issues for the profession. Unprecedented internal and external pressures on the field are likely to require important reconceptualizations of psychiatry both by its members and by the rest of the American public.

Forecasting↗
PubMed1988

Counseling for HIV testing.

Recommendations are presented for counseling individuals who wish to know if they have been infected by the human immunodeficiency virus (HIV). Pretest counseling includes explaining the sensitivity and meaning of HIV antibody tests and the limits of confidentiality, assessing the patient's potential strengths, vulnerabilities, coping capacity, and supportive resources, and mutually deciding if the test is advisable. Populations that have been identified as at risk for HIV infection are listed, and four case vignettes that illustrate the complexity of the decision to be tested are provided. Posttest counseling includes notification of test results, reducing the immediate distress of seropositive patients, educating about how HIV is and is not spread, explaining methods to prevent transmission, advising the patient about who should be told the test results, and arranging follow-up care.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Seizures with neuroleptics and antidepressants.

Seizures remain among the most serious side effects of psychotropic drugs. The authors review the literature associating neuroleptic and antidepressant medications with seizures, discussing the relative "seizurogenicity" of different medications, risk factors for seizures, and drugs of choice for high-risk patients. Case histories are presented. Available evidence suggests that molindone, fluphenazine, and haloperidol are among the least seizurogenic neuroleptics and that doxepin, monoamine oxidase inhibitors, or electroconvulsive therapy may be safest in treating the depressed patient at risk for seizures.

Adult↗
PubMed1984

A case report of mania and congenital deafness.

The authors report treatment of an initial manic episode in a congenitally deaf teenager. It appears that bipolar illness in the deaf is rare and that integrating handicapped patients into a general psychiatric setting may prevent regression.

Adult↗
PubMedDate not supplied

Cost effectiveness of screening for clinical trials by research assistants versus senior investigators.

This study evaluates the relationship between interviewer level of experience and the positive predictive value and cost of telephone screening of subjects for randomized clinical trials. This is a previously uninvestigated area. Respondents to advertisements for chronic depression treatment research received brief, semi-structured telephone interviews (N = 347) either by research assistants (RAs) or by a senior investigator (SI). Those who met criteria based on the phone interview were then interviewed in person using the SCID-P. The RAs did not significantly differ from the SI in the proportion of phone screen positives who were also SCID positive or the proportion of phone screen positives who were randomized. While the SI performed phone interviews significantly faster than the RAs, the SI's higher salary generated a phone screening cost per randomized subject 56% more than that of RAs. The results suggest that trained research assistants are more cost effective than senior investigators for initial screening of depressed patients for research protocols. Further studies are needed to determine whether the findings reported would generalize to other research settings or patient populations.

Adult↗