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Biomedical subjects

R A Sweet

Publications and source records attributed to R A Sweet.

At least 55 records · Page 3Linked to original sources
PubMed1995

Duration of neuroleptic treatment and prevalence of tardive dyskinesia in late life.

BACKGROUND: Although increasing age is the most consistently cited risk factor for the development of tardive dyskinesia for patients in the second to sixth decades of life, this relationship may not hold within geriatric populations. METHODS: Consecutively admitted geropsychiatric inpatients were examined with the Abnormal Involuntary Movement Scale within 72 hours of admission; comprehensive demographic, diagnostic, and psychometric data were also obtained. RESULTS: Seventy-four (19.2%) of 386 patients received diagnoses of dyskinesia. Lifetime duration of neuroleptic use was strongly correlated with dyskinesia rates. After accounting for the effect of lifetime duration of neuroleptic use in a stepwise logistic regression, only associations with Global Assessment Scale score and presence of dental problems remained statistically significant. In comparison with the duration of neuroleptic use, however, the contribution of these factors was minor. Sixteen percent of patients with less than 3 months of neuroleptic use, 29% with 3 to 12 months of neuroleptic use, 30% with 1 to 10 years of neuroleptic use, and 41% with more than 10 years of neuroleptic use had dyskinesia. Compared with patients with no history of neuroleptic treatment, the relative risks for these durations of neuroleptic use were 1.62 (95% confidence limits [CL], 0.81, 3.24), 2.89 (95% CL, 1.50, 5.55), 3.08 (95% CL, 1.66, 5.70), and 4.11 (95% CL, 2.12, 7.96), respectively. CONCLUSIONS: Within elderly populations, duration of exposure to neuroleptics is the strongest predictor of risk for tardive dyskinesia, and this risk increases rapidly within the first year of total lifetime neuroleptic use.

Age Factors↗
PubMed1995

Pharmacokinetics of single- and multiple-dose bupropion in elderly patients with depression.

A study of a dopaminergic antidepressant that may have an advantageous profile for use in elderly patients, bupropion, was conducted to determine the pharmacokinetics of bupropion in the elderly. Pharmacokinetics of single- and multiple-dose bupropion were examined in six elderly patients (five women and one man) diagnosed with depression. Mean (+/- SD) CL app of bupropion was 1.6 +/- 0.4 L/hr/kg, approximately 80% of the corresponding value reported for younger patients. Mean bupropion t1/2 was 34.2 +/- 8.7 hours, and average apparent Vd (Vd app) was 79.3 +/- 29.4 L/kg. Apparent half-lives (t1/2 app) of the metabolites hydroxybupropion, erythrobupropion, and threohydrobupropion were 34.2 +/- 4.6 hours, 61.4 +/- 21.6 hours, and 38.8 +/- 7.6 hours, respectively. After multiple dosing, the mean t1/2 for bupropion and its metabolites did not change significantly, although in some patients the t1/2 app of the metabolites was substantially prolonged. There was also evidence of inordinate accumulation of metabolites. The elderly are at risk for accumulation of bupropion and its metabolites. Specification of therapeutic drug monitoring parameters for bupropion treatment of the elderly is needed.

Administration, Oral↗
PubMed1995

Alcohol and caffeine use by social phobics: an initial inquiry into drinking patterns and behavior.

Social phobics are often fearful that their anxiety symptoms will cause them embarrassment and lead to negative evaluation from others. Thus, it was hypothesized that they might attempt to control the intake of substances such as alcohol and caffeine that may affect their anxiety in social situations. The current investigation sought to determine, via a self-report questionnaire, whether the alcohol and caffeine consumption patterns of social phobics differ from those of community controls in terms of typical and greatest weekly quantities and how social phobics differ from controls in alcohol and caffeine use in a variety of socially threatening and nonthreatening situations. Social phobics reported less typical weekly beverage consumption than community subjects. Specifically, social phobics reported less consumption of wine and liqueur than community subjects but did not differ from community subjects in typical weekly consumption of caffeinated beverages. Further, social phobics reported a significantly greater intent to drink alcohol while in social situations involving strangers and significantly less intent to drink caffeinated coffee in meetings than did community subjects. Finally, a number of gender differences were found for both alcohol and caffeine consumption in specific situations, and the implications of these findings are discussed.

Adult↗
PubMed1995

Prospective cytochrome P450 phenotyping for neuroleptic treatment in dementia.

Older patients have more adverse experiences when treated with psychotropics than younger patients. Age-associated physiological changes, such as reductions in hepatic mass and blood flow, magnify genetic and acquired variations in drug metabolism. Cytochrome P450 2D6 (debrisoquine hydroxylase), which is responsible for the metabolism of several antidepressants and neuroleptics, is constitutionally deficient in up to 10 percent of the population. In this study of 45 elderly patients suffering from dementia and treated with perphenazine, 5 patients who were prospectively identified as poor P450 2D6 metabolizers had significantly greater side effects than the 40 extensive metabolizers.

Aged↗
PubMed1995

Monoamine oxidase inhibitor dietary restrictions: what are we asking patients to give up?

BACKGROUND: Though the list of possible indications for monoamine oxidase inhibitors (MAOIs) continues to expand, many psychiatrists remain hesitant about prescribing MAOIs, citing concerns about dietary prohibitions and hypertensive reactions. Data about psychiatric patients' frequency of consumption of foods, beverages, and medications prohibited during MAOI use are lacking. METHOD: We conducted a survey of 139 psychiatric patients admitted to either an inpatient unit specializing in the treatment of mood disorders or an outpatient anxiety disorders clinic specializing in the treatment of social phobia. At inclusion, patients were not being treated with MAOIs, although they might have received such treatment afterward. All patients completed a self-report questionnaire created for this study to ascertain their consumption of food, beverage, and medication items frequently found on MAOI diet lists. Demographic and diagnostic information was also recorded. RESULTS: The most frequently used high-risk items were the hard cheeses. Ninety percent of patients reported daily or weekly consumption of some food containing cheese, while less than 1% of patients reported never eating hard cheese. Yeast products, dry sausage, corned beef, broad beans, sauerkraut, and beer were used at least monthly by more than 50% of patients. Of the intermediate-risk foods, chocolate was the most frequently consumed, with almost 30% of the patients eating some chocolate daily. Over 40% of patients reported using over-the-counter cold preparations on a monthly basis. CONCLUSION: A wide variety of tyramine-containing foods and contraindicated medications were commonly used by our patients prior to evaluation for possible MAOI pharmacotherapy. The number and diversity of frequently consumed items do not support recommendations to reduce the breadth of restrictions in MAOI diets. Individually targeted dietary assessment and education are recommended to reduce the risks of prescribing MAOIs.

Adult↗
PubMed1995

Prolactin response to neuroleptic challenge in late-life psychosis.

Psychosis in the elderly is superimposed on both age-related and disease-specific declines in dopaminergic function. Though the prolactin (PRL) response to neuroleptic challenge has been used as an in vivo measure of dopaminergic function in midlife adults, it remains uninvestigated in late-life psychoses. We examined the PRL response to intravenous perphenazine (PZ) in 11 elderly patients with psychotic symptoms complicating either a major depression (MD-P) or a dementia. The magnitude of increase in prolactin after PZ divided patients into three non-overlapping groups: dementia patients had a bimodal response and MD-P patients fell between the dementia groups. Our findings suggest that the PRL response to PZ may provide an in vivo measure of dopaminergic function in elderly patients. This finding must be confirmed through correlation with other measures of dopaminergic function in late-life psychoses and with measures of neuroleptic response and neuroleptic-induced extrapyramidal effects.

Aged↗
PubMed1995

Risperidone use in a teaching hospital during its first year after market approval: economic and clinical implications.

Risperidone, a new antipsychotic drug, was recently approved by the Food and Drug Administration (FDA) on the basis of its having comparable efficacy and less toxicity than haloperidol. In a preliminary study to evaluate the therapeutic efficiency of this drug, we conducted a survey of resperidone utilization, cost, and safety during its first year of availability at an academic psychiatric hospital. Data were obtained from a computerized, centralized medical record system, from an adverse drug reaction monitoring system, and from pharmacy purchasing records. In its first year of availability, risperidone became the second most widely used antipsychotic agent at our institution. Most of this use extended beyond the adult schizophrenia population, for whom pre-marketing safety and efficacy data are available. The direct institutional cost of risperidone treatment exceeded the entire budget for antipsychotic drugs during the year before its release. Results from the adverse drug reaction reporting system did not indicate a strong advantage of risperidone over more established antipsychotic agents with respect to extrapyramidal side effects. Furthermore, the mean dose of risperidone associated with extrapyramidal symptoms was 3.5 mg/day, considerably lower than that suggested by pre-marketing studies in a more select patient group. These results confirm that new pharmacological agents are generally used in much broader patient populations than those for which efficacy and safety have been established prior to FDA approval. This study also raises questions about the therapeutic efficiency of risperidone compared with other antipsychotic drugs. We conclude that systematic studies of outcome, safety, and cost of new pharmaceuticals in naturalistic settings are needed to provide the data necessary to establish local standards of cost-effective care.

Adolescent↗
PubMed1994

Ethnicity and psychopathology in an aging hospital-based population. A comparison of African-American and Anglo-European patients.

This study analyzes the effect of ethnicity, classified as African-American and Anglo-European, on diagnosis, symptomatology, and response to inpatient treatment in a sample of geriatric patients of a research unit of a tertiary care facility. Variables that might confound the effects of ethnicity, such as age, gender, education, and associated diagnoses, were statistically controlled. Psychotic diagnoses were significantly associated with ethnicity, being higher in African-Americans, weakening the claim that such an association stems from the confounding effects of social class. Variability in the ratings on the Brief Psychiatric Rating Scale and Hamilton Depression Scale was significantly associated with ethnicity in several instances. African-Americans appeared to obtain comparatively higher therapeutic benefits from hospitalization. Results are discussed using knowledge of the field of cultural and social psychiatry.

Black or African American↗
PubMed1994

Diagnostic rate of comorbid personality disorder in elderly psychiatric inpatients.

Among 547 elderly inpatients grouped by DSM-III-R axis I diagnoses, the diagnostic rate of comorbid personality disorder varied four-fold, from 6% in patients with an organic mental disorder to 24% in those with major depression. The previously reported low prevalence of comorbid personality disorder in geriatric patients may be due to its lower rate of diagnosis among patients with organic mental disorders.

Aged↗
PubMed1994

Impact of acute psychiatric inpatient treatment on major depression in late life and prediction of response.

OBJECTIVE: The authors conducted a prospective study to examine the sociodemographic and clinical characteristics of elderly inpatients with major depression and their response to acute psychiatric hospitalization. The relation between the descriptive variables and clinical response was also investigated. METHOD: The subjects were 205 consecutively admitted inpatients, whose mean age was 71 years, who met the DSM-III-R criteria for major depression. Each subject received detailed physical, psychiatric, and mental status examinations, along with quantitative assessments of psychiatric symptoms and cognitive performance at admission and at discharge. Management of physical problems was optimized, and patients were treated with a combination of somatic and psychotherapeutic interventions. The average duration of hospitalization was approximately 1 month. RESULTS: Despite considerable medical and psychiatric comorbidity, the patients responded well to treatment, as reflected by a 50% reduction in the average score on the Hamilton Depression Rating Scale. Nearly one-half of the patients had experienced the resolution of their depressive symptoms by the time of discharge. Race, cognitive performance at admission, number of medical problems, use of ECT, and length of hospitalization independently contributed to the prediction of clinical response. Response to treatment was not related to the other sociodemographic variables examined or to any of the indexes of severity of depressive episode. CONCLUSIONS: Short-term psychiatric hospitalization offers an effective and efficient vehicle for the treatment of severe or complicated cases of major depression in the elderly, even when considerable medical and psychiatric comorbidity is present.

Age Factors↗
PubMed1994

The Delirium Rating Scale in a psychogeriatric inpatient setting.

The Delirium Rating Scale (DRS) has been shown to be a valid instrument for identifying and grading the severity of delirium in patients admitted to a general hospital for medical or surgical treatment. However, its accuracy in identifying delirium among elderly patients admitted to a psychiatric hospital for evaluation and treatment of psychiatric illness has not been previously addressed. The DRS was administered to 791 elderly patients who were consecutively admitted to a psychogeriatric unit; 70 met DSM-III-R criteria for delirium. A DRS threshold score of > or = 10 correctly identified delirious patients with a sensitivity of 94% and a specificity of 82%. Both psychosis and cognitive impairment appeared to falsely elevate the DRS score in this population.

Aged↗
PubMed1993

Schizophrenia in late life: elderly patients admitted to an acute care psychiatric hospital.

Although a considerable body of biological and clinical data has been accumulated on the mood disorders and organic disorders of late life, only a handful of studies have focused on aging schizophrenia patients. Using the results of a comprehensive evaluation of all elderly patients admitted over a 30-month period to a 26-bed acute care geriatric unit, we compared the demographic, social, and clinical characteristics of schizophrenia patients, patients with recurrent major depression with and without psychotic features, and patients with primary degenerative dementia of the Alzheimer's type with and without delusions. The main findings of this study are that elderly schizophrenia patients were younger, more often African-American, more often single, and poorer than the other groups. A concomitant history of substance abuse and institutionalization as an outcome were more frequent among schizophrenia patients. Like the older depressed and demented patients, schizophrenia patients were predominantly female and commonly presented with several medical disorders. The potential significance of these findings is discussed in the context of the literature on the long-term outcome of schizophrenia.

Aged↗
PubMed1993

Reliability and applicability of movement disorder rating scales in the elderly.

Geriatric research clinicians were readily trained to use three scales initially developed for rating neuroleptic-induced movement disorders in mixed-age patients: the Abnormal Involuntary Movements Scale (AIMS), Simpson Extra Pyramidal Side Effect Scale (SEPSE), and Barnes Akathisia Scale (BAS). Interrater reliability, calculated by intraclass correlation coefficients, ranged from 0.79 to 0.93. Of elderly psychiatric inpatients tested, 97% were able to complete the examination, despite significant psychiatric, cognitive, and physical disabilities. AIMS, SEPSE, and BAS are reliable instruments for assessment of movement disorders in the elderly, representing an important first step in standardized evaluation of dyskinesia, parkinsonism, and akathisia in elderly psychiatric populations.

Aged↗
PubMed1992

Impact of psychiatric hospitalization on behavioral complications of Alzheimer's disease.

OBJECTIVE: The authors conducted a prospective study of the clinical utility of the four DSM-III-R subtypes of primary degenerative dementia of the Alzheimer type (with delirium, with delusions, with depression, or uncomplicated) and acute psychiatric hospitalization for treatment of these subtypes. METHOD: The subjects were 120 consecutive inpatients with Alzheimer's disease, most of whom had behavioral abnormalities. Each subject received detailed physical, neurological, psychiatric, and mental status examinations. The presence or absence of specific behavioral problems was also documented. Patients were treated with medication, psychotherapy, and behavioral techniques. RESULTS: While all patients could be assigned to one of the four DSM-III-R behavioral subtypes, the uncomplicated subtype did not accurately reflect the burden of behavioral symptoms in the patients who did not have delirium, delusions, or depression. Each behavioral subtype responded in a characteristic way to inpatient treatment, as reflected by changes in scores on four psychometric scales used to assess cognitive impairment, psychiatric symptoms severity, and level of functioning at admission and at discharge, as well as by changes in residential setting following hospitalization. Half of all patients admitted from their homes and two-thirds of those with depression were able to go home following discharge. CONCLUSIONS: Behavioral syndromes in Alzheimer's disease should not be overlooked, because they have both clinical and prognostic significance. Short-term psychiatric hospitalization is effective and efficient for achieving the goal of returning patients to their homes and for safely implementing specific treatments in this frail population, and it may reduce the need for institutionalization.

Aged↗
PubMed1980

Vitamin D metabolite levels in oncogenic osteomalacia.

Measurements of 1,25 (OH)2D3 and other metabolites of vitamin D in a patient with oncogenic osteomalacia confirm the selective, reversible deficiency of 1,25 (OH)2D3 in this syndrome, and indicate the rapidity of normalization (within days) of the hormone level and associated hypophosphatemia after resection of the tumor. In this patient, the tumor was an intranasal hemangiopericytoma.

Adult↗