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Biomedical subjects

R E Litman

Publications and source records attributed to R E Litman.

At least 37 records · Page 2Linked to original sources
PubMed1992

Outpatient standards of care and the suicidal patient.

This article is a review of the legal and clinical literature on standards of care for nonhospitalized adult suicidal patients. The authors discuss effective assessment, management and treatment procedures that balance the need for high-quality care by a reasonable and prudent practitioner with the requirements of court-determined and statutory standards. Through a review of malpractice claims data and through an examination of the clinical literature we detail the essential guidelines for sound assessment, intervention, and management procedures. The authors specifically discuss common failure situations in outpatient care (e.g., problems in pharmacotherapy, the decision to hospitalize, inappropriate and dual relationships, the assessment of imminence and lethality, and so on). Details regarding practical considerations in developing an outpatient standard of care are provided, as are suggestions that such a standard of care must include an ongoing assessment of the therapeutic alliance.

Female↗
PubMed1991

The acute effects of central- and peripheral-acting dopamine antagonists on plasma HVA in schizophrenic patients.

The short-term effects of fluphenazine on plasma HVA concentrations were compared with the effects of fluphenazine and concurrent administration of debrisoquin, a monoamine oxidase inhibitor which does not cross the blood brain barrier and is used to enhance the CNS contribution to circulating plasma HVA concentrations. Fluphenazine significantly increased plasma HVA with or without debrisoquin 24 hours following the initiation of treatment. Domperidone, a butyrophenone dopamine antagonist which acts only in the peripheral nervous system, failed to alter plasma HVA concentrations. These data suggest that the acute effects of neuroleptic drugs on plasma HVA concentrations are dependent upon interaction with CNS dopaminergic systems and provide additional support for the use of plasma HVA as a reflection of CNS dopamine system activity in clinical studies.

Adult↗
PubMed1991

Correlation of Wisconsin Card Sorting Test performance with eye tracking in schizophrenia.

The authors studied the relationship between performance on the Wisconsin Card Sorting Test and on the Trailmaking-B test and measures of smooth pursuit eye movements in 12 patients with chronic schizophrenia and 12 normal volunteers. They found that performance on the Wisconsin Card Sorting Test was significantly correlated with measures of smooth pursuit eye movements in schizophrenic patients but not in normal subjects. Trailmaking-B scores, however, were unrelated to smooth pursuit eye movements in either group.

Adult↗
PubMed1990

Neurochemical and neural mechanisms of positive and negative symptoms in schizophrenia.

It is difficult to come away from review of pharmacologic and metabolite studies without concluding that dopaminergic mechanisms play a significant role in mediating both negative and positive symptoms. Nevertheless, the characteristics of dopaminergic involvement are unclear. Whereas compelling evidence continues to link the mechanism of action of neuroleptic drugs, including therapeutic effects on negative and positive symptoms, to blockade of D2 receptors, neuroleptic-induced alterations in dopaminergic function are time-dependent and may include reductions in variability as well as in net dopamine activity. Moreover, pharmacologic enhancement of dopaminergic function may at least transiently improve symptomatology (negative greater than positive) and levels of CSF HVA appear to be reduced or are negatively correlated with symptoms in some schizophrenic patients. Thus, there is support for both increased and decreased dopamine function in schizophrenia. Functional brain imaging has, after only a few years of application, made significant contributions to our understanding of the pathophysiology of schizophrenia. Studies of cerebral metabolism and regional CBF have shown remarkable consistency in their identification of abnormal function of the frontal cortex in schizophrenia. It should be pointed out, however, that agreement across studies remains largely conceptual with significant discrepancies still existing with regard to the precise localization of dysfunction and its relationship to cognitive activation. Although less well documented than 'hypofrontality' itself, negative symptomatology appears to bear some relationship to this defect. The idea that positive symptoms might be associated with increased subcortical and/or metabolism is less well supported. The recent advances in our understanding of structure and function of CNS dopaminergic systems may help to integrate these two bodies of data into more dynamic models of dopaminergic defects in schizophrenia. For example, the concept that diminished mesocortical coupled with increased subcortical dopaminergic activity might be a 'substrate' for psychosis is compatible with neurochemical evidence suggesting both diminished and enhanced dopaminergic processes as well as with metabolic hypofrontality. Better understanding of the regulatory mechanisms involved in establishing functional balance between cortical and subcortical systems might, therefore, identify new possibilities for biological dysfunction in schizophrenia. The recent study by Weinberger et al. which correlates CSF HVA levels with neuropsychologically induced frontal CBF is an example of how neurochemistry can enhance brain imaging data.(ABSTRACT TRUNCATED AT 400 WORDS)

Brain↗
PubMed1989

Smooth pursuit eye movements in schizophrenia: effects of neuroleptic treatment and caffeine.

Abnormal smooth pursuit eye movement (SPEM) has been proposed as a trait marker in schizophrenia. We utilized high resolution infra-red oculography to measure SPEM in 11 neuroleptic-treated schizophrenic patients, 10 drug-free schizophrenic patients, and 11 normals. The most characteristic abnormality was a significant increase in saccadic intrusions during SPEM in schizophrenic patients (p less than .001). SPEM gain was reduced in schizophrenic patients (p less than .005). No significant effects of neuroleptic treatment on SPEM were found, including analysis of seven patients in whom paired data was available. We also measured SPEM prior to and after caffeine ingestion (10 mg/kg) in 10 normals. We found reduced saccadic interruptions as a result of caffeine ingestion compared with placebo (p less than .05). As caffeine has been shown to selectively increase dopaminergic neurotransmission in mesocortical neurons, further study utilizing dopamine agonists during SPEM in schizophrenic patients is warranted.

Adult↗
PubMed1989

Long-term treatment of chronically suicidal patients.

Chronically suicidal persons with chronic psychiatric disorders (dysthymia, recurrent depression, alcoholism/addiction, schizophrenia, personality disorders) challenge the experience and resourcefulness of psychiatrists. The author reviews his 30 years of experience with these patients and makes six recommendations for long-term treatment: (1) a team approach using consultants and ancillary therapists, (2) flexible therapeutic plans combining medication with psychotherapy, (3) care in monitoring transference and countertransference, (4) brief hospitalization at turning points in the patient's life or in the treatment, (5) decisions based on risk-benefit evaluation, and (6) appropriate record keeping. He also summarizes effective treatment approaches with patients who have chronic psychiatric disorders.

Chronic Disease↗
PubMed1989

500 psychological autopsies.

Five hundred psychological autopsies on equivocal (suicide versus accident) deaths were reviewed to ascertain which factors are significant in making the determination between suicidal and accidental deaths. Factors varied in relative importance according to the method used to cause death. Significant factors included life-style, recent stress, suicidal communications, previous self-destructive behaviors, history of depression, and obvious factors from the physical evidence such as large amounts of drugs in the blood. Although the court-provided decision guideline is "a preponderance of the evidence", in practice, the assembled evidence is often used to construct a "most credible" scenario to explain the death.

Accidents↗
PubMed1988

Youth suicide in California: a comparative study of perceived causes and interventions.

Comparative survey data were obtained from five sample groups of respondents composed of young people 12 to 20 years of age, parents of young people within this age range, and respondents to psychological autopsies of decreased youth. The findings revealed that family dysfunction, intrapersonal psychopathology and distress, problems with interpersonal relationships, and drug and alcohol abuse were most frequently mentioned by the respondents as the major causes of youth suicide. In terms of solutions, the availability of social support from family and friends and access to formal intervention programs for troubled adolescents were seen as the most effective measures that could be taken to stop young people from intentionally hurting themselves.

Achievement↗
PubMed1987

Mental disorders and suicidal intention.

This paper continues a previous report (Litman, 1984) in exploring the use of psychological autopsies to clarify intention in suicide; clinical experience is compared with courtroom experience. The certification of suicide requires a judgment that the deceased intended to use his or her own death to resolve his or her problems of living, as demonstrated by a preponderance of the evidence. Now that suicide has been decriminalized, the issue of "sane or insane" in insurance contracts has probably become irrelevant. Mental disorders are important as part of the suicide constellation, as one element of many interacting factors. The capacity to have the intent to commit suicide--that is, to understand the physical nature of one's own death--is lost due to mental disorders only under special and unique circumstances.

California↗
PubMed1984

Psychological autopsies in court.

The crucial concept for defining suicide is intention. A major purpose of the psychological autopsy is to clarify the pre-mortem intentions of the victim, now deceased. This article reports cases in which the issue of suicide vs. accident came to trial because insurance benefits were at issue. Currently, the courts, in considering to what extent mental disorders impair the capacity for intentional self destruction, evaluate each case independently according to its own unique set of facts.

Adult↗
PubMed1983

Deaths related to propoxyphene or codeine or both.

Ninety-nine deaths involving propoxyphene or codeine or both were investigated through interviews with surviving relatives and associates. The criterion for admission to this study was the presence of propoxyphene or codeine in the body fluids or tissues, determined analytically. The codeine-related group included more ethnic minority persons, more histories of primary drug addiction, more users of street drugs, and more accidental deaths. In the propoxyphene-related group there were fewer histories of drug addiction and more persons with mental illness and more suicides. Most victims had considerable past experience with one or both of the drugs and other drugs as well. Propoxyphene was usually obtained by physician prescription. Codeine was often obtained illegally.

Adult↗
PubMed1982

Hospital suicides: lawsuits and standards.

Based on personal experience as an expert witness in litigation following Hospital Suicides, the following recommendations are made: every hospital should have a Suicide Prevention Committee which establishes written guidelines after surveying security areas and talking with staff and patients. Reasonable treatment requires that each patient be evaluated for suicide risk, that a treatment plan be formulated, and that staff follow the treatment plan according to the hospital's own policies.

Adult↗