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Biomedical subjects

N Sussman

Publications and source records attributed to N Sussman.

34 records · Page 2Linked to original sources
PubMed1995

Reactions of patients to the diagnosis and treatment of cancer.

More effective diagnosis and improved treatment have changed cancer from an inevitably fatal to an often curable disease. As a consequence, considerable care needs to be exercised in discussing both the diagnosis and treatment of the disease with the patient or, in the case of children, the parent. Initial reactions to learning that one has cancer include fear of death, disfigurement and disability; fear of abandonment and loss of independence; fear of disruption in relationships, role functioning, and financial standing; and denial, anxiety and anger. An important role of the physician is to recognise these fears and emotions and encourage the patient to share his or her thoughts. It is also important to provide necessary information both to correct misconceptions and to provide hope. Treatment-related concerns add a second source of distress to the patient and, if not optimally addressed, may prejudice the completion of effective treatment. Long courses of treatment may cause the patient to become much sicker symptomatically from the treatment than from the disease itself. Children, in particular, may be unable to tolerate treatment-related side effects. Especially demoralising for the patient are commonly used anti-cancer agents with high emetogenic potential. These include cisplatin, dacarbazine, streptozocin, actinomycin and nitrogen mustard. In many cases, patients suffer so badly from the symptoms of nausea and vomiting that they refuse further treatment. They describe cytotoxic, drug-induced nausea and vomiting as a nightmare. The recent introduction of a new class of anti-emetic agents, the 5-HT3-receptor antagonists, has improved patient quality of life during cytostatic treatment and, in some cases, permitted more aggressive therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Antiemetics↗
PubMed1994

The potential benefits of serotonin receptor-specific agents.

Antidepressant drugs are effective for about three in four people with depression. For reasons that are not understood, individual patients who do not respond to one drug often respond to another. Differences in mechanisms of action may thus be important in determining treatment success or failure. In addition to efficacy, drug side effect profile also determines treatment outcome. In general, the fewer or less severe the side effects of a drug, the greater the degree of compliance with treatment. A major consequence of the introduction of selective serotonin-specific antidepressants is greater patient acceptance due to fewer side effects. Still, some patients are unable to tolerate the nervousness, insomnia, or sexual dysfunction associated with these drugs. Drugs that are even more specific in that they act on specific serotonin receptor subtypes, rather than only by blocking serotonin uptake, may provide efficacy and fewer side effects for patients who do not respond to or tolerate less specific agents.

Antidepressive Agents↗
PubMed1993

Treating anxiety while minimizing abuse and dependence.

Anxiety is common and often disabling. Although effective treatments are available, the use of antianxiety medication remains controversial. Some of the controversy involves the relative benefits of psychological versus pharmacologic interventions. Much of the expressed concern, however, relates to the risks of abuse and dependence associated with standard antianxiety drugs. In some instances, concern about these risks prevents patients from receiving potentially effective treatment. In other instances, failure to recognize possible abuse and dependence results in a clinical dilemma. This presentation will address the factors involved in anxiolytic drug dependence and abuse, including patient characteristics and the pharmacologic profiles of anxiolytic drugs. Specific recommendations about how to minimize abuse and dependence through such measures as diagnostic assessment, patient education, drug selection, and treatment planning will be offered.

Alprazolam↗
PubMed1993

How to manage anxious patients who are depressed.

According to the official nomenclature and the approved indications for psychotropic drugs, anxiety and depression are mutually exclusive, and antidepressants and anxiolytics have a single indication. In clinical settings, however, anxiety and depressive symptoms frequently coexist, and the effects of psychotropic drugs often overlap. Both diagnosis and treatment may be complicated by uncertainty about the primary disorder and the optional therapeutic approach. Available treatment strategies include antidepressants, benzodiazepines, azapirones, and combined antidepressant/anxiolytic therapy. Considerations in reflecting a particular treatment strategy include drug side effects, patient age and medical status, and patient expectations. Recent studies have suggested that antidepressants are effective anxiolytics and that some anxiolytics produce antidepressant effects. Ultimately, any selection should be made based on relative benefits and risks of each approach.

Anti-Anxiety Agents↗
PubMed1991

Bedside clinical and electrophysiological assessment: assessment of change in vulnerable patients.

Current approaches to the diagnosis of delirium are based upon the recognition of symptoms that emerge in the pathological state. As an alternative, we propose an approach to case identification for research purposes based on the recognition of significant changes in the cognitive or cerebral state of the individual patient. Categorical change can be defined using prediction intervals calculated from repeated measures on a population of medically stable subjects. Data from subjects enrolled in a prospective study of delirium in a long-term care population were utilized to calculate prediction intervals for the Mini-Mental Status Examination and for measures of the electroencephalographic background frequency as obtained with a two-channel microprocessor-based EEG device. Preliminary findings support the validity of this quantitative approach for defining changes in brain state. Future research should evaluate both cognitive and electrophysiological techniques for monitoring vulnerable patients.

Aged↗
PubMed1991

The first double-blind, placebo-controlled trial of a partial benzodiazepine agonist abecarnil (ZK 112-119) in generalized anxiety disorder.

This is the first reported controlled trial of a partial benzodiazepine agonist, abecarnil, utilized in the treatment of generalized anxiety disorder (GAD). It was a sequential dose-finding study comparing 15-30 mg/day, 7.5-15 mg/day, and 3-9 mg/day to placebo for 3 weeks of treatment followed by abrupt discontinuation through placebo substitution. Although the two higher dose groups had high incidence of central nervous system (CNS) sedative adverse effects, the 3-9 mg/day group tolerated the medication well with no dropouts. The 3-9 mg/day group, in comparison to the two higher doses and placebo, demonstrated efficacy in global improvement ratings and Hamilton Anxiety Scale (HAM-A) scores. At Week 3, 61 percent of the abecarnil 3-9 mg/day group was rated as at least 50 percent improved on the HAM-A, compared to 30 percent of the placebo group. With abrupt discontinuation there were mild to moderate withdrawal symptoms and loss of efficacy in the two higher dose groups. However, in the 3-9 mg/day abecarnil group, there were few withdrawal symptoms and almost no loss of efficacy following discontinuation.

Adult↗
PubMed1987

Munchausen's syndrome: a reconceptualization of the disorder.

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) delineates three categories of factitious disorders: chronic with physical symptoms (Munchausen's syndrome); factitious disorder with psychological symptoms; and other factitious disorders with physical symptoms. Munchausen's syndrome served as the prototype for all factitious disorders at the time DSM-III was drafted, partly due to the disproportionate attention given to this variant of the disorder. Clinical experience suggests that existing categories do not adequately provide for commonly seen forms of factitious illness. It is now recognized that factitious disorder is the result of a complex interaction of personality factors and psychosocial stressors that often present with both medical and psychiatric symptomatology. Proposed changes in the revised edition of the diagnostic manual DSM-III-R include separate categories of factitious disorder with psychological, physical, and both psychological and physical symptoms. A case report of a patient for whom extensive records and thorough psychological assessment were available is exemplary of a more common course of the disorder (both psychological and physical symptoms) that by current classification would be considered "atypical." A reconceptualization of the disorder that gives emphasis to course and clinical features is suggested.

Adult↗
PubMed1984

Somatoform disorders: before and after DSM-III.

The somatoform disorders were included as a new category of mental disorders in the third edition of the Diagnostic and Statistical Manual of Mental Disorders. The authors review the major features of somatization disorder, conversion disorder, psychogenic pain disorder, and hypochondriasis and present a survey of the recent literature about each.

Adaptation, Psychological↗
PubMedDate not supplied

Relationships of air pollution to health: results from the Pittsburgh study.

The evaluation of adverse health effects resulting from exposure to relatively low levels of regulated air pollutants is currently of major concern. The determination of short-term or acute effects is necessary for this evaluation. By using methodology that directly addressed the time series nature of the data, this study investigated acute health effects of daily levels of air pollution in Allegheny County, Pennsylvania, using both mortality and morbidity events as the adverse health response to ambient pollution. Health effects were determined using the air quality data for sulfur dioxide (SO2) and particulates as measured by the Coefficient of Haze from three monitoring stations located within the county. The mortality analysis provided a replication of a previous study performed in the New York area. The analysis was limited to the investigation of same day effects. Results indicated a possible association between heart disease mortality/morbidity and same day particulate levels. No association between SO2 and mortality/morbidity was seen at the present level of SO2. These findings were in agreement with those obtained in the New York City study and in a re-analysis of London winter data. The need for investigations of delayed effects and weather-mortality/morbidity relationships, as well as evaluation of hospital discharge record information, was stressed.

Air Pollutants↗
PubMedDate not supplied

Aura phenomena and psychopathology: a pilot investigation.

We investigated a possible relation between aura phenomena and psychopathology in patients with seizure disorders. Twenty-one patients with a variety of seizure types (90% with generalized seizures, 72% with complex partial seizures, CPS) were studied. Aura phenomena were evaluated with the Silberman-Post Psychosensory Phenomena Scale; psychopathology was assessed with the Schedule for Affective Disorders and Schizophrenia-Lifetime Version (SADS-L), the Minnesota Multiple Personality Inventory (MMPI), and the Washington Psychosocial Seizure Inventory (WPSI). Psychosensory symptoms occurring in the absence of frank seizures, but not those occurring with seizures, were related to increased psychopathology (primarily mood and anxiety related) and greater time in psychiatric treatment. Psychosensory symptoms may reflect ongoing neurophysiologic dysfunction related to epilepsy and may therefore be a useful subject for further study.

Adaptation, Psychological↗