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Biomedical subjects

M F Folstein

Publications and source records attributed to M F Folstein.

At least 109 records · Page 6Linked to original sources
PubMed1983

The association of affective disorder with Huntington's disease in a case series and in families.

Major affective disorder clinically similar to the disorder found in conditions other than Huntington's Disease (HD) was found in 41% of patients with HD in a consecutive case series ascertained through multiple sources in a defined geographical area. The association appears to be confined to certain families, and affective disorder may appear as long as 20 years before the onset of chorea and dementia. The association may represent genetic heterogeneity in HD.

Adolescent↗
PubMed1983

Conduct disorder and affective disorder among the offspring of patients with Huntington's disease.

The rate of occurrence of conduct disorder and affective illness was studied for a sample of 112 offspring of 34 Huntington's Disease (HD) patients. Psychiatric disorder in the offspring was assessed as a function of: (1) age of the parent at the onset of symptoms of HD; (2) family disorganization; and (3) psychiatric disorder in either parent. The findings indicated an increased frequency of conduct disorder in disrupted families, most especially in those where the HD parent had an early onset of symptoms and the non-HD parent showed psychiatric disorder. Affective disorder in the offspring was most strongly associated with the presence of similar symptoms in the HD parent. Affective disorder, but not conduct disorder, may be an early manifestation of the HD gene. The implication of these findings for genetic counselling is discussed.

Adolescent↗
PubMed1983

The use of life tables and survival analysis in testing genetic hypotheses, with an application to Alzheimer's disease.

Because of the late onset of some neuropsychiatric disorders suspected to be under genetic influence, such as Alzheimer's disease, standard techniques for testing genetic hypotheses are difficult to apply to clinical data. The statistical aspects of life table methods and survival probability estimators which can be used to test such hypotheses have been neglected in the psychiatric literature. Two techniques of this kind, the Weinberg morbidity table and the Kaplan-Meier product limit estimator, are applied to real and simulated data. As estimators of lifetime incidence these methods yield roughly equivalent results for both types of data, although from a theoretical standpoint the original Weinberg estimator appears to suffer from logical defects. Parametric models may offer more definitive results, particularly when an estimator of segregation ratio is required. The clinical data in this report were gathered by interviewing relatives of Alzheimer's disease patients sampled through a nursing home survey in metropolitan Baltimore, Maryland during 1980.

Actuarial Analysis↗
PubMed1983

Quantitative assessment of psychologic state of patients with anorexia nervosa or bulimia: response to caloric stimulus.

Hospitalized patients with anorexia nervosa (N = 17) or bulimia (N = 11) were given a standard liquid meal containing 400 calories. Using analogue scales, bulimic patients were found to have greater anxiety, lower mood, lower sexual arousal, and more fear of fatness than either control or anorectic patients. This finding of increased general "dysphoria" in bulimic patients persisted after the meal without any significant premeal to postmeal changes. Anorectic patients also differed from controls, but less than the bulimic patients. Some measures of anxiety correlated significantly with body mass index before the meal in bulimic patients, whereas in anorectic patients the correlation was significant only after the meal.

Anorexia Nervosa↗
PubMed1983

Psychiatric features of Huntington's disease: recent approaches and findings.

The psychiatric manifestations of Huntington's Disease (HD) include dementia, irritability and apathy, a major affective syndrome, and hallucinosis. The theoretical and practical utility of chorea as a focus of research interest in HD is questioned, whereas the data reviewed suggest that assessments of cognition, functional capacity and motor impairment are better correlated neuropathologically, and are better indicators of disease severity and progress than chorea. The high incidence of major affective disorders on modified DSM III criteria among HD patients (41 per cent) may be explained either as a manifestation of genetic heterogeneity within the HD phenotype or on the basis of genetic linkage between HD and manic depressive illness (MDI). This is supported by the high coincidence of HD and MDI (20 out of 23) among secondary cases of HD ascertained through probands having both disorders, indicating a strong familial clustering of the association. This implies that a young adult at risk for HD who has had episodes of severe depression has considerably more than 50 per cent likelihood of progressing to manifest HD. Although auditory hallucinations appear occasionally in patients with HD, most do not meet current criteria for schizophrenia.

Adolescent↗
PubMed1983

The dementia patient: evaluation and care.

The Mini-Mental State Examination can and should be used as part of the general physical and neurologic examination, both to identify cognitive impairment and to provide baseline information. The primary care physician plays a key role in maximizing the demented person's function by monitoring changing medical needs. Medical resolution of the precipitant may be an important factor in postponing institutionalization.

Aged↗
PubMed1982

Limits of the 'Mini-Mental State' as a screening test for dementia and delirium among hospital patients.

With a psychiatrist's standardized clinical diagnosis as the criterion, the 'Mini-Mental State' Examination (MMSE) was 87% sensitive and 82% specific in detecting dementia and delirium among hospital patients on a general medical ward. The false positive ratio was 39% and the false negative ratio was 5%. All false positives had less than 9 years of education; many were 60 years of age or older. Performance on specific MMSE items was related to education or age. These findings confirm the MMSE's value as a screen instrument for dementia and delirium when later, more intensive diagnostic enquiry is possible; they reinforce earlier suggestions that the MMSE alone cannot yield a diagnosis for these conditions.

Adult↗
PubMed1982

Delirium and dementia: diagnostic criteria and fatality rates.

Medically ill patients diagnosed at index admission as delirious, i.e., suffering cognitive decline and an altered state of consciousness, had higher fatality rates than demented, cognitively intact or depressed patients. At a one-year follow-up the death rate of those who had been delirious was still higher than that of demented patients. Delirious patients were more likely to have a diffusely slow EEG, tachycardia and hyperthermia and lower mean systolic and diastolic blood pressure. These result validate the distinction between delirium and dementia and the importance of alteration of consciousness as a defining characteristics of delirium.

Delirium↗
PubMed1982

Unusual mood stability in patients taking lithium.

The Visual Analogue Mood Scale (VAMS) was completed for 30 consecutive days by 124 psychiatric patients and 36 non-patients control subjects. The 64 euthymic manic-depressive patients on chronic lithium therapy had similar mean mood ratings to the non-patient controls, but had lower mood variability as measured either by standard deviation of the mood rating or by a measure of the mean successive differences between consecutive mood ratings (delta squared). This unusual mood stability appears to be an effect on lithium therapy. This study thus offers some empirical support for the 'mood stabilizer' psychological model of lithium's effects in patients. It is also noted that this effect may be perceived in well patients as an undesirable effect of lithium treatment.

Adult↗
PubMed1982

The course of nausea and vomiting after high-dose cyclophosphamide.

We studied the course of nausea and vomiting after high-dose cyclophosphamide (50-75 mg/kg) in 25 patients. Nausea was assessed with a visual analog scale and vomiting by patient report. The reliability and validity of these methods of assessment were established in separate studies of oncology patients. Nausea and vomiting developed between 6 and 12 hours after the start of a 1-hour cyclophosphamide infusion in about two thirds of the patients. Peak symptoms were at 12 hours. Vomiting had subsided in most of the patients by 24 hours, but nausea persisted. Although there was significant individual variation in the course of nausea and vomiting, we could identify no demographic, disease, drug, or treatment factors which were associated with more significant nausea and vomiting. Some of the variability in the onset, severity, and duration of nausea and vomiting may be related to individual differences in the metabolism of and susceptibility to cyclophosphamide. The visual analog scale may provide information about nausea not obtained by the more frequently employed categoric verbal rating scales. Suggestions for the treatment of nausea and vomiting after high-dose cyclophosphamide are made on the basis of the findings.

Adult↗
PubMed1982

The course of delirium due to lithium intoxication.

Nine delirious patients suffering from lithium intoxication were examined with the Mini-Mental State Exam (MMS) to describe the clinical course of the disorder. Serial serum lithium levels were also obtained. Serum lithium levels fell rapidly, but the cognitive impairment associated with the delirium typically persisted for another week or two. Late-developing but self-limiting neuropsychiatric complications occurred in four patients. The basis of the temporal dissociation of serum lithium levels from the clinical manifestations of lithium intoxication remains uncertain.

Adult↗
PubMed1981

Association of postoperative delirium with raised serum levels of anticholinergic drugs.

Drugs with anticholinegic effects are often used in surgical procedures and may impair higher cognitive functions and produce delirious states. This prospective study examined the relation between serum levels of anticholinergic drugs, measured by a radioreceptor assay, and the development of delirium in patients undergoing cardiac surgery. Most patients who had postoperative delirium had high serum levels of anticholinergic drugs, whereas those who remained cognitively intact had low levels; and impairment in cortical function correlated with serum levels of anticholinergic drugs (p less than 0.001). Raised serum levels of drugs with anticholinergic effects may contribute to the development of delirium, and to the increase in risk of morbidity following cardiac surgery.

Adult↗