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Biomedical subjects

M K Popkin

Publications and source records attributed to M K Popkin.

At least 37 records · Page 2Linked to original sources
PubMed1988

Prevalence of major depression, simple phobia, and other psychiatric disorders in patients with long-standing type I diabetes mellitus.

To examine the prevalence of psychiatric disorders in patients with long-standing type I diabetes mellitus, we assessed a series of candidates for pancreas transplantation. Using the Diagnostic Interview Schedule, six-month and lifetime prevalences of psychiatric disorders were established for the candidates and their potential donors (first-degree relatives). Excluding tobacco use disorder and psychosexual dysfunction, 38 diabetic subjects (51%) received one or more psychiatric diagnoses. The lifetime prevalence of major depression was comparable for female (11 of 48 [22.9%]) and male (seven of 27 [25.9%]) diabetics; both rates were significantly higher than rates in first-degree relatives and the general population. Among female diabetics, the six-month and lifetime prevalences of simple phobia were increased vs donors and the general population; among male diabetics, the lifetime prevalence of antisocial personality disorder was greater than that in the general population. None of these disorders was found to be related to the duration of diabetes or the presence of various complications. The data suggest that increased rates of psychiatric disorder in type I diabetics have both gender-independent and gender-related components.

Adolescent↗
PubMed1987

Antidepressant treatment of medical-surgical inpatients by nonpsychiatric physicians.

The prescribing of antidepressants by nonpsychiatric physicians on adult medical-surgical inpatient services of a university hospital was examined through the review of medical records of patients who received amitriptyline hydrochloride, doxepin hydrochloride, or imipramine hydrochloride during a one-year period. Reasons for antidepressant use were treatment of depression (56%), pain (30%), or other conditions (14%). Regardless of the reason for use, nonpsychiatric physicians were found to use relatively low dosages, rarely plan or effect dosage increases, and rarely discontinue medication.

Adult↗
PubMed1987

Psychiatric consultation to inpatients with 'early-onset' type I diabetes mellitus in a university hospital.

With the use of medical records and the Consultation-Liaison Outcome Evaluation System, we studied psychiatric consultation to 52 hospitalized patients with type I diabetes mellitus having onset of disease by age 25 years. The distribution of psychiatric diagnoses assigned to this sample of patients with "early-onset" diabetes did not differ from those of patients with other medical and surgical illnesses. Three features did distinguish consultation to patients having type I diabetes: the diabetics were referred unusually early in the hospital course; psychotropics were seldom utilized; and consultants' recommendations for diagnostic studies were not followed in more than 90% of cases. The study indicates that the primary medical diagnosis is a critical variable governing consultees' use of and responses to psychiatric consultation.

Adult↗
PubMed1987

Suicide in the medical patient.

According to the statistical abstract of the United States for 1982-1983, there were 1,913,800 deaths in the United States in 1979. Twenty-seven thousand, or 1.4 percent of those deaths were by suicide, yielding a suicide rate of 11.9/100,000/year. The rate was highest (39.2/100,000) for white males sixty-five years and over and lowest (0.1/100,000) for black females between five and fourteen years. It is generally accepted that physical illness is a risk factor for suicide. If this is true, then in caring for persons with significant physical illness, physicians are dealing with a population at increased risk of suicide. In its opening section, this article will review the evidence that points to a positive correlation between suicide and physical illness. Next the association between specific illnesses, such as peptic ulcer and cancer, and suicide will be examined. Third, risk factors associated with the occurrence of suicide in medical-surgical hospitals will be reviewed. Fourth, the occurrence of suicide in relationship to medical procedures will be discussed. Fifth, the evaluation and management of suicidal patients in medical settings will be briefly considered. This review will not consider the relationship between physical illness and attempted suicide.

Adult↗
PubMed1987

Delirium and the resolution of depression.

Two cases are presented in which a long-standing depressive disorder remitted after a protracted delirium associated with the exacerbation of a major medical illness. Although improvement in medical conditions may have contributed to the result, the courses of the affective and medical conditions varied independently before and after the episode of delirium. The prospect of a restitutive function for delirium is further supported by a review of six cases of tricyclic-induced delirium in patients with medical depressive syndromes: the three patients who achieved full resolution of the delirium showed affective improvement.

Antidepressive Agents, Tricyclic↗
PubMed1985

The outcome of antidepressant use in the medically ill.

To examine the feasibility of using antidepressant medication to treat major depressive syndromes in the hospitalized medically ill, we reviewed a series of psychiatric consultations meeting the following criteria: the consultant diagnosed a major depressive syndrome, treatment with an antidepressant was advised, the consultee initiated the antidepressant, and hospitalization had been prompted by a major medical illness. The final sample of 50 consultations, representing less than 5% of the case reviewed, was assessed by retrospective study of entries in the medical record. Judgments regarding response were thus a function of routine clinical observation and care. Drugs were not randomly assigned; rather, the choices represented ongoing clinical usage patterns. Two major points emerge from the data of the study. First, 32% of the trials were terminated due to side effects judged to be unacceptable by the physicians or consultants. Delirium accounted for half of such side effects; cardiotoxicity, however, was not evident. Second, only 40% of patients with medical illnesses, including malignant neoplasm, insulin-dependent diabetes, and epilepsy, responded to treatment. The trials of antidepressants in medical-surgical inpatients did not achieve the pattern of therapeutic responses routinely characterizing comparable interventions in psychiatric patients with primary affective disorder.

Adult↗
PubMed1985

Data-based psychiatric consultation: applying mainframe computer capability to consultation.

Critical, intertwined objectives for consultation psychiatry include 1) the development of data-based clinical practices, and 2) heightening the effectiveness of consultation. Toward these ends, the Consultation Psychiatry Service at the University of Minnesota has previously conducted systematic studies of consultation and established an ongoing data collection system for consultations. Both steps have relied extensively upon mainframe computer capability. This primary application of computer capability to the field of psychiatric consultation is reviewed by the authors.

Computers↗
PubMed1985

Pedagogic applications of a computerized data base.

The educational experience of medical students taking a 6-week clerkship in consultation psychiatry was augmented by clinical simulations. Using a microcomputer program and a video-display terminal the students are confronted with an actual case and asked to make specific recommendations. The program records their answers and then indicates what the consultant actually did. This method broadens the student's clinical exposure, provides prompt feedback, frees staff to supervise live patient contact, and offers the possibility of sharing clinical problems with other centers.

Aged↗
PubMed1984

Psychiatric consultation to geriatric medically ill inpatients in a university hospital.

Using hospital admissions data, medical records, and the Consultation-Liaison Outcome Evaluation System, we studied psychiatric consultation to hospitalized medical-surgical patients who were aged 60 years or older. In comparison with younger patients, the geriatric population was less often referred for psychiatric consultation. Those referred had less prior psychiatric history than the group aged less than 60 years. They received a different distribution of psychiatric diagnoses. Consultants recommended psychotropic medication and diagnostic actions more often for the elderly; the former was related to the presence of organic mental disorder. Concordance with consultants' recommendations and diagnoses did not vary with patients' age. Certain aspects of the consultation process are thus modified when geriatric patients are involved, and specific features of "geriatric consultation" are unique.

Age Factors↗
PubMed1984

Difficulties in the physician-patient dyad: invoking the psychiatric consultant.

Drawing upon their studies of physicians' responses to the recommendations and diagnosis of psychiatric consultants, the authors propose that the psychiatric consultant is most often invoked when the primary physician experiences an inappropriate interpersonal distance in the relationship with the patient. Sensing the threat or the reality of the patient as too close or too distant, the physician seeks the presence of the consultant. In the subsequent triadic constellation, the psychiatric consultant is suggested to function principally as buffer between the physician and the patient, restoring, or effecting a more optimal interpersonal distance in the original dyad. This construct helps to explain the consultees' "selectivity" in requesting consultation and the marked disparity between reported prevalence of psychiatric disorders in the medically ill and referral rates. It also calls attention to the role of the psychiatric consultant in assuring that the medical care of the patient with psychiatric features is not compromised or abbreviated.

Humans↗