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Biomedical subjects

R R Reeves

Publications and source records attributed to R R Reeves.

At least 19 recordsLinked to original sources
PubMed2001

Does EEG predict response to valproate versus lithium in patients with mania?

A number of factors may suggest that a patient with mania may respond to valproate or to lithium. However, prediction of which patients will respond to either medication remains difficult. In this study nonepileptiform EEG abnormalities in responders to each medication were investigated. Six of 20 patients (30%) responsive to lithium but not to valproate had nonepileptiform EEG abnormalities while 14 of 20 patients (70%) responsive to valproate but not to lithium had nonepileptiform EEG abnormalities. Patients presenting with mania and EEG abnormalities, particularly sharp activity, are statistically more likely (chi2 = 4.9, df = 1, p = .027) to respond to valproate than to lithium. Whether such a finding will also hold true for other anticonvulsants used to treat mania remains to be seen.

Acute Disease↗
PubMed2001

Neuroleptic malignant syndrome during a change from haloperidol to risperidone.

OBJECTIVE: To report a case of neuroleptic malignant syndrome (NMS) in a patient whose therapy was being switched from haloperidol to risperidone. CASE REPORT: A 57-year-old African-American man, treated for schizophrenia with haloperidol for several years, developed NMS within 48 hours of the addition of low doses of risperidone and mirtazapine to his regimen. Symptoms, which included fever, generalized rigidity, and altered mental status, resolved after discontinuation of psychotropics, supportive management, and several weeks of treatment with bromocriptine and dantrolene. He was subsequently treated with olanzapine without adverse effects. DISCUSSION: Several cases of NMS have been reported with risperidone, but none under these circumstances. NMS most likely occurred in this patient as a result of the additive dopamine 2 receptor blocking of haloperidol and risperidone. Sympathetic hyperactivity secondary to mirtazapine may also have been a contributing factor. If NMS may be induced by the simultaneous use of older, high-potency antipsychotics and newer, atypical antipsychotics such as risperidone, switching patients from older to newer antipsychotics may at times be difficult, since completely stopping one antipsychotic before starting the second may place patients at risk for psychotic relapse. CONCLUSIONS: Clinicians should closely monitor patients receiving both haloperidol and risperidone or combinations of similar medications.

Antipsychotic Agents↗
PubMed2001

Abuse of combinations of carisoprodol and tramadol.

Neither carisoprodol (Soma) nor tramadol (Ultram) is a controlled substance at the federal level. However, evidence indicates that these medications may have abuse potential, particularly in patients with a history of substance abuse. We report three cases in which a combination of carisoprodol and tramadol was used illicitly to obtain psychotropic effects. Carisoprodol or tramadol should be prescribed with caution for patients at risk for substance abuse, and extreme caution should be used when prescribing both drugs simultaneously for any patient.

Adult↗
PubMed2000

Unrecognized medical emergencies admitted to psychiatric units.

Alteration of mental status secondary to medical illness may occasionally be incorrectly attributed to a psychiatric problem. The cases of 64 patients with unrecognized medical emergencies inappropriately admitted to psychiatric units from emergency departments were reviewed to determine the cause of the misdiagnoses. Medical diagnoses most often missed included severe intoxication with alcohol or other illicit substance (34.4%), drug or alcohol withdrawal or delirium tremens (12.5%), and prescription drug overdose (12.5%). In none of the cases (0%) was an appropriate mental status examination performed. Other common causes of misdiagnosis included inadequate physical examination (43.8%), failure to obtain indicated laboratory studies (34.4%), and failure to obtain available history (34.4%). A systematic approach is required for patients with altered mental status, including those with psychiatric presentations.

Alcoholic Intoxication↗
PubMed2000

Topographic quantitative analysis of the intrinsic alpha rhythm in chronic obstructive pulmonary disease.

Twenty-two patients with documented COPD and no other significant illnesses were studied to assess the effect of varying degrees of COPD on the intrinsic alpha rhythm. The severity of COPD was determined by spirometry with assessment of FEV1, FVC, and FEV1/FVC. The alpha frequency for COPD patients was slower than that which characterizes age equated normals and averages 1.6 S.D. below normative data base mean values (range -0.43 S.D. to -1.85 S.D.). Impairment of pulmonary functioning significantly correlated with the degree of alpha frequency slowing over the posterior cortical regions, and the slowest alpha frequencies occurred in those COPD patients with the lowest FEV1/FVC ratios. Impairment of cognitive functioning is thus an important clinical consideration in treatment of patients with COPD but may go unrecognized until late in the course of the disease.

Aged↗
PubMed2000

Valproate-induced tinnitus misinterpreted as psychotic symptoms.

Valproate sodium is an anticonvulsant medication, which has also been shown to be effective in the treatment of bipolar disorder. We report a case of valproate-induced tinnitus that was initially misinterpreted as increasing psychotic symptoms, which began approximately 2 days after initiation of valproate therapy. Tinnitus worsened during the next 6 days of treatment until it was recognized that this symptom was related to valproate. After discontinuance of the medication, the tinnitus gradually resolved over a period of 10 days with no residual effects. Although it is a rare adverse effect, valproate-induced tinnitus should be included in the differential diagnosis for tinnitus in patients receiving this medication. Tinnitus may be difficult to recognize in patients with active psychosis or mania.

Antimanic Agents↗
PubMed1999

The effects of caffeine withdrawal on cognitive P300 auditory and visual evoked potentials.

Auditory and visual P300 cognitive evoked potentials were obtained in 13 individuals who regularly consumed caffeine prior to and during a 4 day period of abstinence from caffeine. During the period of caffeine abstinence auditory P300 evoked potentials showed significant decreases in amplitude measures but no significant changes in latency, while the visual P300 evoked potentials showed significant latency decreases but no significant changes in amplitude. The reason for these opposite effects is unclear and further research in this area is needed.

Adolescent↗
PubMed1999

Auditory and visual P300 cognitive evoked responses in patients with COPD: relationship to degree of pulmonary impairment.

Twenty-two subjects with documented COPD and no other significant illnesses were studied to assess the effect of varying degrees of COPD on cognitive P300 auditory and visual evoked potentials. The severity of COPD was determined by spirometry with assessment of FEV1, FVC, and FEV1/FVC. Auditory P300 latency was significantly correlated with the FEV1/FVC ratio (Pearson Product Moment correlations r = -.56, N = 20, probability level = 0.1), indicating that increasingly severe airflow impairment is associated with longer auditory P300 latencies. There was no significant association of FEV1/FVC with visual P300 latency or with auditory or visual evoked potential amplitude measures. Progressive impairment of the auditory P300 evoked potential latency occurs with increasing severity of COPD. This impairment is present even in patients with mild COPD, suggesting some degree of accompanying cognitive decline early in the course of COPD with worsening as the disease progresses.

Electroencephalography↗
PubMed1999

Carisoprodol (soma): abuse potential and physician unawareness.

Carisoprodol is a noncontrolled skeletal muscle relaxant whose active metabolite is meprobamate, a Schedule IV controlled substance. Although several case reports have shown that carisoprodol has abuse potential, it continues to be widely prescribed. The usage patterns of 40 patients who had taken carisoprodol for three or more months (20 of whom had no history of substance abuse and 20 of whom carried a diagnosis of substance abuse or dependence) were reviewed and compared and a survey was conducted to assess physician awareness of the abuse potential of the drug. Findings showed that some patients using carisoprodol for over three months may abuse the medication, especially those individuals with a history of substance abuse. A significant percentage of the physician population is unaware of the potential of carisoprodol for abuse and of its metabolism to meprobamate, a controlled substance. Physicians should exercise caution when prescribing carisoprodol, especially if the patient has a history of substance abuse.

Adult↗
PubMed1999

The effects of donepezil on the P300 auditory and visual cognitive evoked potentials of patients with Alzheimer's disease.

Donepezil is a cholinesterase inhibitor used for the treatment of patients with mild to moderately severe Alzheimer's disease (AD). The purpose of this study was to determine the effect of treatment with donepezil 5 mg qd on cognitive evoked potentials (EPs) of patients with AD. Although treatment with donepezil did not normalize EP latencies, treatment was associated with a significant decrease in the auditory P300 latency (mean latency pretreatment=401. 5 msec; posttreatment=392.7 msec.; P=0.04), and the visual P300 latency (mean latency pretreatment=605.7 msec; posttreatment=580.3 msec; P=0.04). Treatment with donepezil had no discernible effect on auditory or visual P300 EP amplitudes.

Aged↗
PubMed1998

Mnemonics for DSM-IV substance-related disorders.

A series of acronyms was developed to assist in recalling the DSM-IV diagnostic criteria for substance-related disorders. In order to facilitate recall, most of the mnemonics are related in some way to the disorder itself. In general, each letter of the acronym relates to an element of the diagnostic criteria. These mnemonics are intended to be helpful in a variety of academic and medical settings.

Abbreviations as Topic↗
PubMed1998

Medicolegal errors in the ED related to the involuntary confinement of psychiatric patients.

To determine the effectiveness of emergency department (ED) physicians properly and correctly completing documents required for emergency confinement of psychiatric patients, 1,000 Physician Emergency Certificates filed by ED physicians in the Shreveport, Louisiana, region were reviewed for appropriateness and for correctness of completion based on the applicable state law. Of the Physician Emergency Certificates reviewed 4.2% were incomplete or inappropriate. The most significant sources of error involved incomplete documentation of the mental status examination and not documenting the specific reason (dangerous to self, dangerous to others, or gravely disabled) for the patient meeting requirements for involuntary confinement. Other errors included confinement for reasons not appropriate for a psychiatric unit. This study suggests that ED physicians should be more cautious and thorough in completing the documents required for emergency confinement of psychiatric patients, so that the physician is less likely to be sued for malpractice or charged with the false imprisonment of such patients, and the patient's civil liberties are protected.

Emergency Medical Services↗
PubMed1998

TRI-PLEDs.

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Adult↗