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Biomedical subjects

L Ganzini

Publications and source records attributed to L Ganzini.

46 records · Page 3Linked to original sources
PubMed1991

The prevalence of tardive dyskinesia in neuroleptic-treated diabetics. A controlled study.

In a controlled study, we compared the prevalence of tardive dyskinesia in 38 neuroleptic-treated diabetics with the prevalence of tardive dyskinesia in a group of 38 nondiabetic neuroleptic-treated controls, matched for age, sex, psychiatric diagnosis, and dose and duration of neuroleptic treatment. Members of each group were evaluated for movement disorders by a rater who used standard rating scales and was "blind" to all diagnoses and treatments. Neuroleptic-treated diabetics had a significantly higher prevalence and severity of tardive dyskinesia. There were no differences between groups on other possible risk factors for tardive dyskinesia, including parkinsonism, anticholinergic drug treatment, or cognitive function. These data suggest that diabetes mellitus should be examined further as a risk factor for tardive dyskinesia.

Age Factors↗
PubMed1990

Prevalence of mental disorders after catastrophic financial loss.

In a controlled study, the authors determined the risk of developing major mental illness after catastrophic financial loss. Seventy-two adults who lost their retirement savings in a bank fraud were interviewed using the Diagnostic Interview Schedule. Major depression by DSM-III criteria was present in 29% of the victims during the first 20 months after their loss as compared with 2% of 66 age, gender, and residential area-matched control subjects (p less than .0001). Generalized anxiety disorder as defined by DSM-III criteria was experienced by 27% of victims after the loss as compared with 10% of control subjects (p = .03). After the loss, victims had lower subjective health ratings, more functional somatic complaints, and higher tranquilizer usage than control subjects. There was no difference between depressed and nondepressed in types of coping responses or use of social supports and confidants. Only four of 21 victims who suffered major depression sought help from a mental health professional. We conclude that catastrophic financial loss may result in the onset of major depressive disorder and generalized anxiety disorder.

Adaptation, Psychological↗
PubMed1990

Victims of fraud: comparing victims of white collar and violent crime.

Mental health professionals have focused attention on the psychiatric sequelae of criminal victimization. This article compares the experience of white collar and violent crime victims on several parameters including statistical risk of victimization and psychiatric outcome after victimization. Emphasis is given to data obtained from interviewing 77 victims of a fraudulent financial scheme.

Adaptation, Psychological↗
PubMedDate not supplied

Perceptions of academic vulnerability associated with personal illness: a study of 1,027 students at nine medical schools. Collaborative Research Group on Medical Student Health.

About one quarter of the more than 69,000 medical students in this country suffer symptoms of mental illness, including 7% to 18% with substance use disorders. Subjective distress and physical health needs of medical students are also common and have been linked to training stresses. This first large-scale study of medical student health care examined students' physical and mental health concerns and their perceptions of academic vulnerability associated with personal illness. A 7-page, confidential written survey was given to 1,964 students at nine US medical schools in 1996 and 1997. A total of 1,027 students participated (52% response rate). Nearly all (90%) reported needing care for various health concerns, including 47% having at least one mental health or substance-related health issue. A majority of students expressed a preference for health care outside their training institution, largely due to confidentiality concerns, and 90% preferred health insurance allowing off-site care. Students expressed varying levels of concern about academic jeopardy in association with personal illness, with physical health problems such as arthritis causing the least concern and alcohol and drug abuse triggering the most concern. Consistent differences were detected in these views based on respondent's gender, training level, and institution. Most medical students perceive the need for personal health care. Nevertheless, fear of academic reprisal may prevent medical students from seeking necessary care for their health problems during training. This phenomenon may be linked in important but poorly recognized ways to emerging illness and to impairment among medical students and physicians. Women, minority, and clinical students appear more sensitive to the connection between health and academic vulnerability. Constructive implications for medical school curricula, policies, and health care services are discussed.

Adult↗
PubMedDate not supplied

Acute extrapyramidal syndromes in neuroleptic-treated elders: a pilot study.

The incidence, morbidity, and risk factors for acute extrapyramidal syndromes (EPS) such as akathisia and drug-induced parkinsonism (DIP) in neuroleptic-treated elders have not been systematically explored. This study presents data on 17 elderly patients who were prospectively examined for up to 4 weeks for acute EPS, functional and cognitive status, and behavioral disturbances. Seventy-one percent of subjects developed DIP, and 18% developed akathisia. Predictors of DIP included pre-neuroleptic treatment parkinsonian signs and neuroleptic dose, despite use of low doses of neuroleptics. Development of acute EPS was associated with failure to improve behaviorally. New-onset urinary incontinence was the most common functional abnormality.

Aged↗
PubMedDate not supplied

Drug-induced depression in the aged. What can be done?

Over 10% of medically ill elderly persons have concurrent major depression, and medical illness is the most influential stressor contributing to depression in old age. The contribution of prescribed medications to depression in the medically ill is poorly understood. Most information on drug-induced depression is derived from case reports; 43 classes of medications have been implicated, including reserpine, beta-blockers, levodopa, corticosteroids, and antipsychotics. However, large rigorously performed studies of some drugs, particularly antihypertensives, suggest that drug-induced depression is uncommon and idiosyncratic. There is no evidence that age is an independent risk factor for drug-induced depression. However, elderly persons are the largest consumers of prescribed drugs, and the burden of drug-induced depression is carried by the old. Because of the frequency of atypical presentations of mental disorders in the elderly, drug-induced depression is often misdiagnosed. Nevertheless, basic principles of geriatric medicine offer useful guidance to clinicians in evaluating the complex interrelationships between prescribed medications and depression. We recommend an approach that includes regular inquiry into the common symptoms of mood disorders, vigilance in assessing the contribution of drugs in their development, but scepticism in assessing a depressive episode as caused only by medication.

Aged↗
PubMedDate not supplied

Drug-induced mania in the elderly.

Mania is a rare complication of prescribed drug use in elderly persons. The drugs most likely to produce mania include corticosteroids and dopamine agonists. It is uncertain if antidepressants cause mania or only increase the propensity for latent bipolar mania to be expressed. Drug-induced mania may promote poor judgment, risk-taking behaviours and medical noncompliance. The majority of episodes of drug-induced mania are short-lived and respond to discontinuation of the drug. Antipsychotic agents may hasten resolution of this psychiatric syndrome. Lithium may prevent corticosteroid-induced mania, but the role of lithium in the treatment of other drug-induced manic episodes has not been studied adequately.

Aged↗
PubMedDate not supplied

Misdiagnosing delirium as depression in medically ill elderly patients.

BACKGROUND: Delirium, a common and often overlooked syndrome in acutely ill elderly patients, may present with signs and symptoms of depression. OBJECTIVE: To determine (1) how often health care providers mistake delirium for a depressive disorder in older hospitalized patients referred to a psychiatric consultation service for depressive symptoms and (2) which signs and symptoms of depression and delirium characterize these patients. SUBJECTS: Patients older than 60 years, admitted to a Veterans Affairs teaching hospital, and consecutively referred to a psychiatric consultation service for evaluation and treatment of a depressive disorder. METHODS: The diagnosis of delirium was based on two independent assessments: (1) a clinical interview by a member of the psychiatric consultation service and (2) a structured bedside evaluation performed by one of the investigators, who was not a member of the psychiatric consultation service. The investigator administered the Confusion Assessment Method Instrument, Mini-Mental State Examination, digit span forward, and months of year backward. The investigator also administered the Diagnostic Interview Schedule items for depression to elicit depressive symptoms. RESULTS: Twenty-eight (41.8%) of the 67 subjects referred for evaluation or treatment of a depressive disorder were found to be delirious. Compared with nondelirious subjects, the delirious subjects were older and more impaired in activities of daily living. The delirious subjects often endorsed depressive symptoms, such as low mood (60%), worthlessness (68%), and frequent thoughts of death (52%). The referring health care provider had considered delirium in the differential diagnosis of the mood disturbance in only three subjects. CONCLUSION: Health care providers should consider the diagnosis of delirium in hospitalized elderly patients who appear to be depressed.

Activities of Daily Living↗