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Biomedical subjects

S L Dubovsky

Publications and source records attributed to S L Dubovsky.

At least 37 records · Page 2Linked to original sources
PubMed1996

Shortening length of stay without increasing recidivism on a university-affiliated inpatient unit.

The impact of reducing length of stay on readmission rates was examined for privately insured patients treated on a traditional inpatient unit or in an alternatives program with a shorter stay and a continuum of acute care. Billing data were analyzed for length of stay and readmission rates for all admissions between 1985 and 1992 (N = 1,363). The traditional unit was reorganized in 1990 into the alternatives program. Although the program decreased mean length of stay from 20.2 days to 6.2 full-day equivalents, overall readmission rates did not increase (17.2 percent, compared with 18.6 percent for the traditional unit). Rates increased for a subgroup of patients with psychotic disorders (from 13.7 to 35.2 percent).

Adolescent↗
PubMed1995

Beyond specificity: effects of serotonin and serotonergic treatments on psychobiological dysfunction.

Serotonin is a ubiquitous neurotransmitter with widespread projections that provide for the involvement of serotonin in the regulation of many biological and psychological functions. A variety of serotonin receptor subtypes exist that mediate overlapping psychobiological functions and that are targets for a new generation of medications. Although these new generation medications appear to possess great biochemical specificity, their actions extend to many psychiatric disorders, reflecting the many interactions of serotonergic subsystems.

Brain↗
PubMed1995

The use of opiate antagonists for recurrent self-injurious behavior.

Despite a plethora of studies on the behavioral and pharmacologic treatment of self-injurious behavior, and despite our best efforts, many patients continue to harm themselves. The authors review the literature on the use of opiate antagonists for the treatment of self-injurious behavior.

Adolescent↗
PubMed1995

Opiate antagonists for recurrent self-injurious behavior in three mentally retarded adults.

Opiate antagonists have shown promise for treating a subset of self injurious patients. The authors report on the use of naltrexone with three mentally retarded adults who had long histories of self-injurious behavior and unsuccessful behavioral and drug treatments; for all three, the self- injurious behavior was substantially decreased. The authors have found a positive response for half the self-injurious patients for whom naltrexone has been tried. Before any drug therapy is initiated, environmental reinforcers of the behavior should be sought out and modified, and any reversible medical and psychiatric disorders should be treated.

Adult↗
PubMed1995

Valproate-associated pancreatitis and cholecystitis in six mentally retarded adults.

BACKGROUND: Pancreatitis is usually considered a rare side effect of valproate. We describe five cases of pancreatitis and one case of cholecystitis associated with the use of valproate. METHOD: Through chart review, we identified all patients in our facility treated with valproate between 1989 and 1994, and all cases of pancreatitis and cholecystitis identified during that same period in our population of 322 mentally retarded patients. We also searched MEDLINE for all published cases of pancreatitis or cholecystitis associated with valproate treatment. RESULTS: Five (7%) of 72 valproate-treated patients experienced pancreatitis, and one experienced cholecystitis; all recovered fully. This brings the total number of reported cases of valproate-associated pancreatitis to 55. CONCLUSION: Pancreatitis may occur more frequently than previously recognized in mentally retarded adults treated with valproate. Developmentally disabled patients should be carefully monitored for this potentially lethal side effect.

Adult↗
PubMed1995

Serotonergic mechanisms and current and future psychiatric practice.

The participation of serotonin (5-HT) in the regulation of diverse biological and psychological functions makes it possible for medications acting on 5-HT subsystems to play a role in the treatment of a growing number of psychiatric and medical disorders. The actions of new medications on the 5-HT reuptake mechanism are complemented by actions on the 5-HT receptors and on other neurotransmitter systems that may be effective in complex and treatment-resistant syndromes. New drugs acting on one or more of the seven major 5-HT receptor classes that have been identified thus far appear to be promising for the treatment of specific subtypes of psychiatric syndromes, from depression to anxiety to schizophrenia. A given serotonergic medication may be useful for more than one disorder because it acts on specific dimensions of psychobiological malfunction that characterize more than one disorder, dimensions that are mediated by more than one receptor.

Anxiety Disorders↗
PubMed1994

Intracellular calcium signalling in peripheral cells of patients with bipolar affective disorder.

Consistent with previous studies, elevated free intracellular calcium ion concentrations ([Ca2+]i) were found in blood platelets and lymphocytes of patients with mania and bipolar depression. Incubation with an ultrafiltrate of plasma from patients with bipolar illness had no effect on intracellular calcium ion concentration in platelets from normal subjects, suggesting that elevated [Ca2+]i is not due to a circulating factor. As was true in an earlier study of the effect of lithium on platelets, incubation with therapeutic levels of carbamazepine lowered [Ca2+]i in lymphocytes from affectively ill patients but not controls. Increased [Ca2+]i in peripheral cells may reflect a diffuse change in cellular homeostasis and may contribute to mixtures as well as rapid alternations of activity of affective, behavioral and physiologic systems in bipolar illness. Correction of the abnormality may at least be a marker of a relevant therapeutic action if it is not the action itself.

Bipolar Disorder↗
PubMed1994

Challenges in conceptualizing psychotic mood disorders.

Psychotic mood disorders represent a complex group of syndromes in which depression and/or mania are accompanied by delusions, hallucinations, or both. The presence of psychotic features has a profound influence on the course and treatment response of mood disorders, and psychotic disorders in turn are influenced by coexisting dysregulation of mood. Psychosis and mood, along with other features such as severity, a high rate of recurrence, psychomotor changes, dissociation, and mental states reflecting a history of trauma, appear to interact to alter each other's expression. The treatment of psychotic mood disorders, regardless of coexisting conditions, requires pharmacotherapy--usually a combination of an antipsychotic drug and a medication for mood--or electroconvulsive therapy. The results of treatment are usually positive.

Affect↗
PubMed1994

Beyond the serotonin reuptake inhibitors: rationales for the development of new serotonergic agents.

Serotonin (5-HT) is a neurotransmitter involved in the regulation of mood, arousal, aggression, sleep, learning, nociceptions, nerve growth, and appetitive functions. Medications that act on 5-HT and its receptors have applications in the treatment of a variety of psychiatric disorders, among them depression, anxiety, psychoses, eating disorders, obsessive compulsive disorder, body dysmorphic disorder, posttraumatic stress disorder, and conditions associated with aggression. The clinical effects of these medications depend not only on their capacity to increase synaptic concentrations of 5-HT, but also on their effects on subtypes of 5-HT receptors and on other neurotransmitter systems. A new generation of drugs acting on specific 5-HT receptors has the advantage of a low frequency of adverse effects, applicability in mixed and complicated syndromes, and usefulness as probes of the psychobiology of mental disorders. An understanding of the specific actions of these medications on cellular communication and signaling makes it easier to predict their applications and disadvantages in specific clinical syndromes. The diverse applications of this new generation of drugs suggest a reconceptualization of the categorical approach to diagnosis and the addition of a more dimensional approach, at least to psychopharmacology.

Antidepressive Agents↗
PubMed1993

Calcium antagonists in manic-depressive illness.

Increased free intracellular calcium ion concentration ([Ca2+]i) has been found in lymphocytes and blood platelets of patients with bipolar affective disorders when they are acutely ill, but not after recovery. Because lithium alters intracellular calcium ion dynamics and lowers platelet [Ca2+]i in affectively ill patients but not controls, drugs whose primary action is to modulate [Ca2+]i in hyperactive cells have been used as antimanic agents. The best studied of these is verapamil, a calcium channel blocking agent (CCB) that appears most effective for lithium-responsive patients. Because they interact with different central CCB receptors, second-generation CCBs may have a different spectrum of action. CCBs are usually well tolerated and may be useful for a number of other psychiatric, neurological and medical conditions.

Bipolar Disorder↗
PubMed1993

Approaches to developing new anxiolytics and antidepressants.

The empirical approach to new treatments for anxiety and depression has been to test series of compounds that resemble medications in current use until one is found with similar actions but with fewer side effects. With the explosion of knowledge in neurobiology, it is becoming possible to develop treatments aimed more precisely at specific links in the chain of mood dysregulation. Examples of this informed approach include agonists for limbic but not cortical benzodiazepine receptors; compounds to stabilize serotonergic and noradrenergic transmission; and drugs that act on intracellular signals, such as the calcium ion and cyclic AMP. This article reviews neurobiologically informed approaches to developing new medications for anxiety and depression and discusses some of the innovative treatments that are emerging from such a strategy.

Anti-Anxiety Agents↗
PubMed1992

Abnormal intracellular calcium ion concentration in platelets and lymphocytes of bipolar patients.

The authors measured intracellular Ca2+ concentrations in four manic and five bipolar depressed patients and seven comparison subjects. Platelet and lymphocyte intracellular Ca2+ concentrations were comparable. The patients' mean intracellular Ca2+ concentrations were higher than those of the comparison subjects and demonstrated more interindividual variation. These findings suggest a diffuse abnormality in mechanisms affecting intracellular calcium homeostasis in bipolar disorder.

Adult↗
PubMed1992

The calcium second messenger system in bipolar disorders: data supporting new research directions.

Studies of aberrations in second messenger function may help to elucidate some of the multiple complex neurobiological alterations in bipolar affective disorders. The phosphatidylinositol and calcium ion (Ca2+) second messengers are of particular interest because of evidence of hyperactivity of these signaling mechanisms in both mania and bipolar depression and of their normalization by lithium and other mood-stabilizing treatments. Because the intracellular Ca2+ signal has a biphasic action, a single aberration could explain diverse clinical manifestations of the same illness, and a single action on the messenger could explain the biphasic actions of many treatments for bipolar disorders.

Bipolar Disorder↗
PubMed1992

Psychotic depression: advances in conceptualization and treatment.

Psychotic depression is a unique subtype of depressive illness in which mood disturbance is accompanied by delusions, hallucinations, or both. Once considered relatively uncommon, it is frequently encountered in clinical practice, particularly in treatment-resistant depressed patients. Psychotically depressed patients respond poorly to antidepressants, but remission is likely with neuroleptic-antidepressant combinations or electroconvulsive therapy. Psychotic depression may be unipolar or bipolar with early or late onset and may be more likely to occur in patients with a history of childhood psychic trauma. Much is known about the course and treatment response of obvious presentations of psychotic depression, but more must be learned about depressed patients who have intermittent, subtle, or mild psychotic symptoms and about the ways in which the capacity to become psychotic interacts with the capacity to become depressed to produce a syndrome greater than the sum of its parts.

Affective Disorders, Psychotic↗
PubMed1991

Elevated platelet intracellular calcium concentration in bipolar depression.

Baseline and thrombin-stimulated free intracellular calcium concentrations in blood platelets were significantly higher in untreated depressed bipolar patients than in untreated unipolar depressed patients or controls. Platelet intracellular calcium ion concentrations in euthymic-treated bipolar patients were equivalent to control values, suggesting but not proving a state-dependent change in intracellular calcium ion dynamics in bipolar depression. Unipolar and some subsets of bipolar patients appear not to exhibit this change.

Adult↗