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Biomedical subjects

L F Ramirez

Publications and source records attributed to L F Ramirez.

At least 19 recordsLinked to original sources
PubMed2000

Preoperative FDG-PET temporal lobe hypometabolism and verbal memory after temporal lobectomy.

OBJECTIVE: To examine the relationship of preoperative fluorodeoxyglucose (FDG)-PET asymmetry in temporal lobe metabolism and memory outcome after anterior temporal lobectomy (ATL). METHODS: In a university-based epilepsy surgery center, 60 ATL patients (27 left, 33 right) were divided into two groups: no/mild (n = 21) or moderate/ severe (n = 39) asymmetry in temporal lobe hypometabolism as determined by FDG-PET. All patients were nonretarded, at least 18 years of age, left-hemisphere speech dominant, without MRI abnormalities other than hippocampal atrophy, and with unilateral temporal lobe origin of intractable complex partial seizures. Neuropsychological measures of intelligence and verbal and visual memory function were assessed preoperatively and 6 months postoperatively. RESULTS: Left ATL patients with no/mild asymmetry in FDG-PET temporal lobe metabolism exhibited significantly greater verbal memory decline compared with left ATL patients with moderate/severe hypometabolism. There was no significant relationship between PET asymmetry and pre- to postsurgical IQ change. No significant relationship was observed between extent of PET hypometabolism and memory outcome for right ATL patients. CONCLUSIONS: FDG-PET asymmetry can be added to the preoperative clinical markers that appear useful in predicting verbal memory decline after left ATL.

Adult↗
PubMed2000

A pictoral guide to pediatric epilepsy surgery.

This article contains a discussion and detailed pictorial account of diagnostic and neurosurgical therapeutic procedures used to help pediatric patients who have medically intractable epilepsy. The operations discussed are placement of sphenoidal electrodes, strips and grids, temporal and extratemporal resections, corpus callosotomy, and hemispherectomy.

Child↗
PubMed2000

An assessment of clinical practice of clozapine therapy for veterans.

Clozapine therapy for 2,996 patients with treatment-refractory schizophrenia was examined over a five-year period in the Veterans Affairs health care system. Patients were assessed with the Brief Psychiatric Rating Scale (BPRS) and the Abnormal Involuntary Movement Scale (AIMS). BPRS scores, which were available for 522 patients, indicated a significant improvement, as did AIMS scores, which were available for 252 patients. Compared with individuals who showed a modest improvement, those with a more robust response to clozapine had higher initial BPRS scores and were three times more likely to have been suicidal in the month before starting clozapine therapy.

Adult↗
PubMed2000

Neuroscience education of undergraduate medical students. Part II: outcome improvement.

OBJECT: Because of political and economic pressures, primary care physicians are now charged with greater responsibility for the care of patients with disease processes definitively managed by neurosurgeons. The goal of this study was to establish the feasibility and efficacy of a neurosurgical curriculum designed to teach future primary care physicians about these diseases. METHODS: A compact, seven-lecture curriculum was developed to teach 3rd-year medical students about degenerative spine disease, stroke, tumor- and hydrocephalus-related raised intracranial pressure, head and spine injury, and subarachnoid hemorrhage. This curriculum was given as part of a 6-week pilot course that included neurology, neurosurgery, ophthalmology, and rehabilitation medicine components. This course was administered to two groups of 18 medical students, and an examination was administered at the end of the pilot course. The same examination was administered to an additional 19 students immediately after their completion of the neurology course currently required. Students enrolled in the pilot neuroscience course performed significantly better (p<0.001) on the examination than those who had completed the standard neurology course. Striking improvements were noted in the recognition and management of head injury, hydrocephalus, and radiculopathy. CONCLUSIONS: Inclusion of a short neurosurgery-related curriculum in a combined neuroscience course significantly improved student performance on an examination focusing on the recognition and management of common neurosurgical disorders. Because primary care physicians are responsible for the initial recognition and management of these disorders, the knowledge gained may lead to improved patient care.

Brain Neoplasms↗
PubMed1998

Clozapine therapy for older veterans.

OBJECTIVE: The effectiveness of clozapine treatment in a treatment-refractory sample of older adult veterans with primary psychosis was examined. METHODS: Data were collected over a five-year period for patients age 55 and older who were given clozapine because of a history of treatment-refractory or treatment-intolerant psychosis. At initiation of clozapine therapy, baseline demographic, clinical, and psychopathology data were collected. At baseline and quarterly, patients' psychopathology was rated with the Brief Psychiatric Rating Scale (BPRS), and involuntary movements were rated with the Abnormal Involuntary Movement Scale (AIMS). RESULTS: The 329 patients age 55 or older who received clozapine during the study period represented 10 percent of all patients on clozapine therapy in the VA system. Of the 312 patients for whom demographic information was available, 294 were men and 18 were women. Overall, patients improved on clozapine therapy, although wide variation in drug response was observed. Complete BPRS and AIMS data were available for 97 patients. The 55- to 64-year-old group had a mean improvement in total BPRS score of 19.8 percent, with 42.6 percent showing more than a 20 percent improvement; those age 65 and older had a mean improvement of 5.7 percent, with 17.2 percent showing an improvement greater than 20 percent. The 97 patients with complete AIMS data showed a mean improvement of 16.6 percent in total score. CONCLUSIONS: Clozapine is an important therapeutic agent for older adults with treatment-refractory psychosis. Patients between the ages of 55 and 64 may have a better response than those age 65 and older.

Adult↗
PubMed1998

Olanzapine therapy in elderly patients with schizophrenia.

Compared to young adults, elderly individuals with schizophrenia may have a six-fold increase in the prevalence of tardive dyskinesia. The atypical antipsychotic, olanzapine, may offer particular benefit for this population. This is a prospective, open-label trial of olanzapine therapy in elderly schizophrenic patients. Individuals aged 65 years or older with DSM-IV schizophrenia and a history of neuroleptic responsiveness were given olanzapine as an add-on therapy to their existing medication regimen. Other antipsychotic medication was gradually discontinued. Psychopathology was assessed using the Brief Psychiatric Rating Scale (BPRS). Abnormal movements were assessed with the Simpson-Angus Neurological Rating Scale (SA), the Barnes Akathisia Scale (BA), and the Abnormal Involuntary Movement Scale (AIMS). Cognitive status was assessed with the Mini-Mental State Evaluation (MMSE). Twenty-seven individuals received a mean dosage of 8.4 (+/- 4.2) mg/day. Mean age of the group was 70.6 (+/- 4.1) with a range of 65 to 80 years. Patients had a mean of 1.6 (+/- 1.4) significant comorbid medical illnesses. Change in BPRS scores were not significant for the group as a whole, whereas SA score change was substantial, with a pre-treatment mean of 13.7 (+/- 10.3), compared with a mean of 4.8 (+/- 4.1) for those treated with olanzapine (p < .0002). Changes in AIMS and BA score were also significant on olanzapine therapy. MMSE score change was not statistically significant. Comorbid medical illnesses were not adversely affected. Olanzapine is an effective antipsychotic medication in older adults with schizophrenia, and is associated with significant improvement in extrapyramidal side effects. Implications for effect on cognitive status should be explored in larger, long-term trials.

Aged↗
PubMed1997

Outcome of clozapine therapy for elderly patients with refractory primary psychosis.

OBJECTIVE: The objective was to analyze outcome of clozapine therapy in elderly patients with treatment refractory primary psychosis. DESIGN: This was an open-label clozapine trial in elderly patients. Patient psychopathology was assessed before and after clozapine therapy. SETTING: A psychiatry service at a large urban/suburban Veterans Administration Medical Center. PATIENTS: Inpatients and outpatients age 65 years or older with primary psychotic disorders established to be resistant to conventional antipsychotic therapy (Kane et al., 1988). Ten patients met study inclusion criteria out of a total of 134 patients receiving clozapine at the Cleveland VAMC (7.5%). Mean age of the group was 70.6 years. MEASURES: Patients were rated with the Brief Psychiatric Rating Scale (BPRS; Overall and Gorham, 1962). Additional data on patient demographics, comorbid non-psychiatric diagnoses and concurrent psychotropic medication were collected via chart review. RESULTS: Mean clozapine dosage was 204 mg/day for a mean duration of 430 days. 7/10 patients had some degree of clinical improvement and 3/10 patients had significant improvement documented by BPRS change of 20% or greater. Patients had a mean of 1.4 comorbid physical illnesses, which were not worsened by clozapine therapy. 4/10 patients discontinued clozapine therapy due to adverse effects or inability to comply with bloodwork; however; only 2/10 were truly treatment intolerant. CONCLUSIONS: Clozapine is a useful alternative treatment option for elderly individuals with refractory primary psychosis. As in younger patients, inability to tolerate drug-related adverse effects or weekly bloodwork may lead to drug discontinuation.

Aged↗
PubMed1996

Outcome of risperidone therapy in elderly patients with chronic psychosis.

OBJECTIVE: This report reviews the efficacy and tolerability of risperidone therapy in elderly patients with chronic psychosis. METHODS: A computer search was conducted for all patients who were sixty-five years or older at the time of risperidone therapy at the Cleveland VAMC. Data collected included psychiatric diagnosis, risperidone dosage/side effects, concurrent medications, comorbid medical diagnosis, and response to treatment. Treatment response was quantified on a graduated scale. RESULTS: Twenty-six patients age sixty-five or older were included in this sample. Mean age of the group was 70.4 years. Mean risperidone dosage was 3.8 mg/day for a mean duration of 251 days. Eighteen of twenty-six patients (69%) had schizophrenia, two of twenty-six (8%) had schizoaffective disorder, two of twenty-six (8%) had bipolar disorder, and four of twenty-six (15%) had other psychotic disorders. Patients had a mean of 2.4 medical diagnoses in addition to their primary psychiatric diagnosis. Twenty-two of twenty-six patients (85%) had clinical improvement on risperidone, and twenty of twenty-six (77%) had improvement that was either marked or moderate. Risperidone therapy was very well tolerated in this elderly population with nineteen of twenty-six patients (73%) remaining on risperidone therapy at completion of this study. Medical illness did not appear to be worsened or complicated by risperidone therapy. CONCLUSION: Risperidone appears to be an effective and well tolerated antipsychotic for elderly patients with chronic psychosis.

Aged↗
PubMed1996

Risperidone therapy in treatment refractory acute bipolar and schizoaffective mania.

This pilot study evaluated the efficacy of risperidone therapy in patients with bipolar I or schizoaffective mania who were treatment resistant or treatment intolerant. Patient psychopathology and involuntary movements were evaluated with a variety of scales, and risperidone was administered on an open-label basis. Five of six patients (all bipolar) discontinued risperidone therapy because of adverse drug effects (2 patients), lack of significant drug response and subjective clinical worsening (1 patient), or worsening of manic symptoms (2 patients). One patient with schizoaffective illness improved. Risperidone used without the addition of a mood stabilizer was ineffective in treating pure manic psychosis. In some vulnerable bipolar patients, risperidone monotherapy may have antidepressant activity that could exacerbate mania. If risperidone proves to have antidepressant activity, it may become an important agent in the therapy of patients with depressive symptoms and psychosis.

Adult↗
PubMed1993

Psychiatric manifestations of olivo-ponto-cerebellar atrophy and treatment with clozapine.

Patients with multiple system atrophy, a neurodegenerative disease entity, have a high incidence of associated mental disturbances such as a mood disorder with or without psychotic features. Treatment of the psychiatric symptoms, without compromising neurological status, is often complicated and unsuccessful. This article describes a patient with olivo-ponto-cerebellar atrophy and treatment-resistant psychotic depression whose psychiatric symptoms were successfully treated with clozapine without aggravating the neurological disabilities.

Clozapine↗
PubMed1990

Effects of six months of clozapine treatment on the quality of life of chronic schizophrenic patients.

The effect of approximately six months of treatment with clozapine on the quality of life of 38 treatment-resistant schizophrenic patients was prospectively studied in an open trial. The Quality of Life Scale was used to provide an objective measure of changes in patients' psychosocial functioning. Significant improvement was noted on all four factors of the scale. The ratings tended to be negatively correlated with ratings on the Brief Psychiatric Rating Scale at baseline and at six months. At 12 months, patients' rehospitalization rate was reduced by 83 percent and was independent of the six-month quality-of-life ratings.

Adult↗
PubMed1989

A prospective study of clozapine in treatment-resistant schizophrenic patients. I. Preliminary report.

Preliminary results of a non-blinded prospective study of the effect of clozapine on symptomatology and social function in 51 treatment-resistant schizophrenic patients are reported. The mean duration of treatment at the time of this report was 10.3 +/- 8.1 months, median 7.6 months. Overall, 3/51 patients (60.8%) showed at least a 20% decrease in total BPRS, a criterion of improvement in the study of Kane et al. (1988). Four of 51 (7.8%) had at least a 50% decrease in total BPRS. Improvements in both positive and negative symptoms were noted. Marked improvements in social function were noted within the first 6 months of treatment. Improvement was first noted at all time points, with only 45.2% of improvers being identified after 6 weeks of treatment. These results suggest a 6-12-month trial may be desirable before deciding to discontinue clozapine because of insufficient response. Higher total Brief Psychiatric Rating Scale (BPRS) score and higher ratings on the Paranoid Disturbance subscales of the BPRS were factors which discriminated clozapine responders from non-responders.

Adult↗