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Biomedical subjects

L E Hollister

Publications and source records attributed to L E Hollister.

At least 19 recordsLinked to original sources
PubMed2000

An approach to the medical marijuana controversy.

The use of smoked marijuana as a therapeutic agent is presently a matter of considerable debate in the United States. Many people suffering from a variety of disorders maintain that it is necessary for their adequate treatment. Yet, the evidence to support claims is insufficient for FDA approval. An interim solution is proposed which would allow patients referred by their physicians to participate in a 6-month program of legal marijuana availability, similar to the 'compassionate IND' program of a number of years ago. A technique similar to that used for post-marketing surveillance is proposed for obtaining quantitative data for a limited number of potential indications. These are: (1) nausea and vomiting associated with cancer chemotherapy or other causes, (2) weight loss associated with debilitating illnesses, (3) spasticity secondary to neurological diseases, and (4) chronic pain syndromes.

Cannabis↗
PubMed1999

A survey of hospital practices related to pelvic and rectal examinations of psychiatric inpatients.

Fifty-three inpatient units in Texas and Massachusetts--15 free-standing psychiatric hospitals and 38 units of general hospitals--responded to a survey to determine current practice in conducting pelvic and rectal examinations of psychiatric patients. Pelvic examinations were never done at 15 of the facilities (28 percent), and rectal examinations were never done at 12 (23 percent). The other facilities did these examinations selectively based on patients' clinical history. Because selective use of these examinations is consistent with recommendations of the American Psychiatric Association and because hospitals that conduct examination selectively have received approval by the Joint Commission on Accreditation of Healthcare Organizations, it appears that selective rather than routine pelvic and rectal examinations are now considered reasonable practice.

Hospitalization↗
PubMed1999

Calcium channel blockers in psychiatric disorders: a review of the literature.

OBJECTIVES: To review the published literature of the past 15 years regarding use of calcium channel blockers (CCBs) in psychiatric practice. These drugs, especially verapamil, have been recommended as possible treatments for mania and other disorders. METHODS: The Cumulative Medical Index and other databases were searched and back-tracked to locate relevant articles. Sixty-one such articles were uncovered: 37 anecdotal reports, 7 partially controlled reports, and 17 controlled trials. RESULTS: Most studies involved treatment of mania using verapamil. Although anecdotal reports were generally favourable, results from partially controlled reports or controlled clinical trials were mixed. Generally, verapamil was less effective than was lithium or placebo. Treatment of depression with CCBs was not very successful, regardless of the type of trial; the best trial was negative. The same was true for the treatment of schizophrenia, although the cases studied were extremely chronic and treatment-resistant. Evidence for efficacy in other illnesses, such as Alzheimer's disease or tardive dyskinesia was scanty but suggested that further trials might be in order. CONCLUSIONS: CCBs do not at present have an established place in psychiatric treatment. Nonetheless, clinicians faced with a manic patient not responsive to other antimanic drugs, either alone or in combination, might consider adding verapamil as an adjunct. A study bearing on this specific issue is needed to determine whether or not such off-label use would really be justified.

Calcium Channel Blockers↗
PubMed1996

Structural brain scanning in psychiatric patients: a further look.

BACKGROUND: Indications for computed tomographic (CT) and magnetic resonance (MR) scans of the brain in psychiatric patients are not clearly defined. This survey attempted to refine indications suggested by an earlier survey. METHOD: All brain scans ordered in a psychiatric teaching hospital were surveyed over a period of approximately 23 months. A revised order sheet provided information about the assumed need for scanning as well as indicated those factors from the previous survey most likely to reveal pertinent information. Scan results were later correlated with this information. RESULTS: Of 68 scans reviewed, 40 were normal, 16 equivocal, and 12 were abnormal. Cognitive decline and/or confusion were indications for 30 scans; 7 were abnormal, all meriting a clinical diagnosis of Alzheimer dementia. Only 1 of 12 scans to investigate a history of head injury was abnormal. Only 2 of 11 scans based on a history of seizures were abnormal; all had other possible indications. In one patient a prior stroke was confirmed, and in another, active multiple sclerosis. Ten of the group of 12 abnormal scans were found in patients over the age of 40 years, emphasizing the influence of age. CONCLUSION: Revised indications based on this second survey were as follow: (1) The importance of new or unexplained focal neurologic signs was confirmed; (2) Scans are useful for bolstering a clinical diagnosis of Alzheimer disease; (3) A first psychotic break or personality change after the age of 50 years will require investigation; (4) Cognitive decline in a patient with a prior history of functional psychosis is most likely part of the psychosis rather than a confounding organic disorder; (5) Isolated seizures of long duration or abnormal EEG without other clinical findings are seldom associated with abnormal scans.

Adolescent↗
PubMed1995

Electrocardiographic screening in psychiatric patients.

BACKGROUND: Present recommendations vary regarding the use of screening ECGs in psychiatric patients; therefore, this study was undertaken to determine the utility of routine screening electrocardiograms (ECGs) in hospitalized psychiatric patients. METHOD: Twelve-lead ECGs were obtained on 1006 consecutive admissions to an academic freestanding 250-bed public psychiatric hospital over a period of 2 years. RESULTS: Tracings were read as normal in 765 of 1006 cases. Tracings of 148 patients were considered to be equivocal, mainly due to nonspecific T wave abnormalities seen in 118 patients. In 29 patients, no ostensible cause for the T wave abnormalities was found. Among the remaining 80 instances, abnormalities were attributed to drug abuse. Especially prevalent was recent cocaine abuse, often with concurrent alcohol abuse (N = 30); recent alcohol abuse alone (N = 10); or concurrent psychotherapeutic drugs (lithium, N = 19; thioridazine, N = 9; and miscellaneous drugs, N = 12). Subclinical hypothyroidism was found in 5 and borderline hypokalemia in 4 patients. Ninety-three tracings were definitely abnormal; one half of these were among patients over 50 years of age. Only 5 of 162 tracings in patients under 20 years of age were abnormal; one of these (incomplete right bundle branch block) might have mattered had the patient been considered for treatment with drugs that lengthen intraventricular conduction times, such as tricyclic antidepressants or thioridazine. CONCLUSION: Routine screening ECGs done on psychiatric patients yielded relatively few abnormalities except in those over the age of 50 years, confirming the experience with such surveys in the general population. The prevalence of abnormalities among these patients was frequent enough to merit routine screening. For other patients regardless of age, ECGs are indicated whenever a history or physical findings suggest cardiovascular disease or whenever it is proposed to treat these patients with psychotherapeutic drugs known to increase cardiac conduction times or otherwise alter cardiac function.

Adult↗
PubMed1994

New psychotherapeutic drugs.

Many new psychotherapeutic drugs are being developed for the major clinical indications for which they might be useful. As usual, we hope not only to obtain better drugs but also to posit hypotheses based on the presumed mode of action of effective drugs. Thus, we have a chance to test the role of serotonin, via the 5HT1A receptor, in anxiety or to test the possible significance of multiple benzodiazepine receptors. Among antidepressant agents, we have a chance to determine the relative roles of norpinephrine and serotonin in the pathogenesis of these disorders. We may also determine whether antidepressant actions involve a number of aminergic neurotransmitters. Among antipsychotic drugs, the importance of dopamine D2 receptor blockade has diminished with the advent of atypical drugs affecting a variety of other receptors. It might also be possible to delineate more clearly the role of serotonin in psychosis. The GABA hypothesis of mania can be tested in a number of ways by current drugs. The role of calcium antagonism remains to be demonstrated. The acetylcholine hypothesis of Alzheimer's disease will be tested further by new compounds under trial. However, it seems increasingly doubtful that current drugs under test will explicate the current hypothesis of the abnormal processing of beta-amyloid precursor protein in that disorder. Thus, we hope, as we have for the past three decades, to be able to use drugs not only to treat, but also to generate hypotheses. It is a kind of bootstrapping enterprise, but our ultimate hope is not only to be better able to treat our patients, but also to better understand their afflictions.

Clinical Trials as Topic↗
PubMed1992

Stability of psychiatric diagnoses among acutely ill patients.

A survey of patients admitted four or more times to the same acute care psychiatric hospital over a period of 3 years revealed that only 56 of 162 (34%) of such patients were discharged with the same diagnosis on each admission. Instability of diagnosis occurred despite the fact that previous diagnoses were known and that only relatively few diagnoses contributed to this degree of chronicity. Schizophrenia and mania were the most stable diagnoses with considerable overlap between them. Organic disorders were a variable diagnosis, often made in the context of chronicity, substance abuse or uncertainty. A diagnosis of substance abuse usually occurred in the context of other comorbid diagnoses which sometimes took precedence. Instability of diagnosis will continue so long as the diagnostic system is based so heavily on clinical criteria.

Adolescent↗
PubMed1992

Verapamil versus lithium in acute mania.

Twenty acutely manic patients were studied in a double-blind randomized trial comparing verapamil with lithium. The Petterson Mania Scale, the Brief Psychiatric Rating Scale (BPRS), and the Clinical Global Impression (CGI) were administered before treatment and weekly during 4 weeks of treatment to evaluate response to verapamil and lithium. Both treatment groups improved significantly, and there were no significant overall differences between treatments.

Acute Disease↗
PubMed1991

Predicting lithium dose by the body-weight method.

A method for predicting steady-state lithium concentration based on body weight calculated at 0.5 mEq/kg/day produced serum levels within the therapeutic range of 0.6 to 1.2 mEq/l in 20 of 23 patients (22 patients if the less conservative level of 1.4 mEq/l had been used). Had the one-point method been used, in which doses are based on the serum lithium concentration 24 h after a 600 mg test dose, the doses would have been lower in 20 of 23 patients. This neglected approach to predicting lithium doses could scarcely be either more accurate or simpler.

Adult↗
PubMed1991

Clinical use of CT and MR scans in psychiatric patients.

During a three-year period, 337 CT or MR scans were ordered for psychiatric patients in a teaching hospital. Scans were normal in 185 instances, equivocal in 34, and abnormal in 118 instances. When a history of neurologic disorder and/or the presence of abnormal neurologic/organic mental signs was positive, scans were abnormal in 74% of cases; when these indicators were negative, scans were normal in 72% of cases. In all, only 4 new diagnoses were made. Two patients, both with markedly abnormal neurological findings, were shown to have brain tumors, which changed their management. Two others showed abnormalities which would have been missed, both of which were of no clinical consequence. The following are suggested as sound indications for ordering CT or MR brain imaging among psychiatric patients: 1) positive history of head injury, stroke or other neurologic disease, as well as suspected Alzheimer disease or multi-infarct dementia; 2) presence of abnormal neurologic signs or organic mental signs, such as confusion or cognitive decline; and, 3) a first psychotic break or personality change after the age of 50 years.

Brain↗