Search PubMed⌕ Search

Biomedical subjects

M N Starkman

Publications and source records attributed to M N Starkman.

31 records · Page 2Linked to original sources
PubMed1979

Teaching medical gerontology: utilization of a psychiatry consultation program.

This is a report of a pilot project designed to explore the feasibility of using the clinical Adult Service Psychiatry Consultation-Liaison Program at the University of Michigan as the locus for teaching medical gerontology to psychiatric and medical/surgical house officers and medical students. The goals, general techniques, educational content, and implementation procedures are described. Evidence was obtained that teaching medical gerontology through the program is both feasible and effective. Since a nonphysician gerontologist implemented the clinically based teaching program, the project is an example of the possibilities inherent in a multidisciplinary clinical teaching program.

Aged↗
PubMed1978

EEG changes and serum cortisol levels in cushing's syndrome.

Thirty-three patients with Cushing's syndrome had baseline serum cortisol levels and EEG's prior to medical treatment. The EEG's were often normal or showed minor abnormalities consisting of mild slowing and disorganization of background activity, excessive fast activity, and minor paroxysmal changes with sharp waves and some small spike-waves. Of 30 not having intracranial tumors there was a general trend toward worsening of the EEG with increased serum cortisol levels.

Adenoma↗
PubMed1977

Fetal monitoring: psychologic consequences and management recommendations.

The psychologic consequences of fetal monitoring were investigated by means of structured interviews with 35 postpartum women. Both beneficial and detrimental effects associated with the use of fetal monitors were identified. Personality characteristics and past experiences with pregnancy and labor were found to be factors shaping the manner in which the monitor was experienced. Areas of prepartum and intrapartum care indentified in which the potential for maximizing the beneficial aspects of monitoring and reducing the detrimental ones exist. Specific management recommendations are given.

Adolescent↗
PubMedDate not supplied

The effect of elevated systemic cortisol levels on plasma catecholamines in Cushing's syndrome patients with and without depressed mood.

This study explored the effect of elevated systemic cortisol levels on plasma epinephrine and norepinephrine, and hemodynamic variables, in patients with active Cushing's syndrome; ratings of depressed mood were also obtained. Norepinephrine levels were significantly negatively correlated with 24 h urinary free cortisol levels. Cushing's patients without depressed mood showed more robust negative correlations than those with depressed mood. The inverse relationship between norepinephrine and cortisol is consistent with data obtained previously in acute studies of normal subjects. Mechanisms which might explain these relationships include changes in control of catecholamine production, release, and or metabolic clearance in Cushing's patients. The decrease in the strength of association in depressed Cushing's patients is consistent with prior studies that suggest abnormal relationships between hypothalamic-pituitary-adrenocortical activity and noradrenergic function in major depressive disorder.

Adult↗
PubMedDate not supplied

Psychological responses to the use of the fetal monitor during labor.

Fetal monitoring, a major advance in obstetrical care, transforms the labor room into an intensive care setting. The psychological effects of this new technology were investigated by means of structured interviews with 25 postpartum women. The multiplicity of psychological responses obtained are described. The relationship of demographic, obstetrical, and psychosocial variables to women's overall positive or negative reaction to the monitor was investigated. Personality characteristics and life experiences with pregnancy and childbirth were factors that shaped the manner in which the monitor was experienced. The effect of fetal monitoring on maternal anxiety is discussed. The impact of mechanization on the total experience of childbirth is noted.

Anxiety↗
PubMedDate not supplied

Pseudocyesis: psychologic and neuroendocrine interrelationships.

There is a paucity of information concerning the interrelationship of psychiatric and neuroendocrine abnormalities in pseudocyesis. We have studied two patients using a multimodal investigatory approach, with particular attention to the association of depression and alterations in endocrine secretory patterns. Both patients had abnormal growth hormone secretory patterns, as demonstrated by lack of sleep-associated peaks and the absence of a response to L-dopa administration. Both patients had elevated testosterone and estradiol levels and normal prolactin levels. Only the patient who met DSM III criteria for a major depressive episode had abnormally elevated luteinizing hormone (LH) levels and large LH pulse amplitudes. These findings, together with a review of cases reported in the literature, suggest that no single neuroendocrine profile is common to all patients with pseudocyesis.

Adult↗
PubMedDate not supplied

Peripheral catecholamine levels and the symptoms of anxiety: studies in patients with and without pheochromocytoma.

We studied the correlation of plasma and urinary epinephrine (E) and norepinephrine (NE) levels with anxiety symptoms in three patient groups: 1) pheochromocytoma (PH+) (n = 17); 2) hypertensives with elevated catecholamine levels shown not to have a PH (PH-) (n = 25); and 3) patients with panic disorder (PD) (n = 23). Structured interviews and four self-rated anxiety scales were used: the SCL-90R Anxiety and Phobic Anxiety scales, and the Spielberger State/Trait Anxiety Inventories. The SCL-90R Somatization scale (which measures 12 somatic symptoms) was also utilized. None of the PH+ patients met DSM-III criteria for PD. Two met criteria for generalized anxiety disorder (GAD). Of the PH- patients, two had PD, two had GAD, and three had both. Urinary and plasma E did not show significant positive correlations with any of the four anxiety scales in any of the three patient groups. In both the PH+ and PH- groups, E was significantly correlated with the SCL-90R Somatization scale. NE was not significantly correlated with any of the four anxiety scales in the PH+ group. In contrast, in the PH- group, plasma NE was significantly correlated with anxiety on all anxiety scales (r = +0.55 to +0.77, p less than 0.05). Furthermore, in the PH- group, plasma NE was significantly correlated with those items of the SCL-90R Anxiety scale measuring the cognitive rather than the noncognitive symptoms of anxiety. In the PD group as well, plasma NE showed a significant correlation with the SCL-90R Anxiety Scale (r = +0.67, p less than 0.05). Taken together, our observations suggest that: 1) the effects of catecholamines in the periphery derived from a source independent of nervous system control (such as a PH) are not sufficient to elicit an anxiety disorder meeting DSM-III criteria; and 2) in patients without an autonomous source of peripheral catecholamines, NE in the periphery results from sympathetic nervous system activation and probably reflects, rather than causes, anxiety.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

Elevated cortisol levels in Cushing's disease are associated with cognitive decrements.

OBJECTIVE: The objective of this study was to use Cushing's disease as a unique human model to elucidate the cognitive deficits resulting from exposure to chronic stress-level elevations of endogenous cortisol. METHODS: Forty-eight patients with a first episode of acute, untreated Cushing's disease and 38 healthy control subjects were studied. RESULTS: Scores for four of five verbal IQ subtests were significantly lower in patients with Cushing's disease; their scores were significantly lower for only one nonverbal performance IQ subtest (block design). Verbal, but not visual, learning and delayed recall at 30 minutes were significantly decreased among patients with Cushing's disease. Although verbal delayed recall was significantly lower in these patients, the retention index (percentage), which compares the amount of initially learned material to that recalled after the delay, was not significantly decreased. There was no significant association between depression scores and cognitive performance. A higher degree of cortisol elevation was associated with poorer performance on several subtests of learning, delayed recall, and visual-spatial ability. CONCLUSIONS: Chronically elevated levels of glucocorticoids have deleterious effects on particular domains of cognition. Verbal learning and other verbal functions seem more vulnerable than nonverbal functions. The results suggest that both the neocortex and hippocampus are affected.

Adult↗