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Biomedical subjects

S L Satel

Publications and source records attributed to S L Satel.

35 records · Page 2Linked to original sources
PubMed1991

Clinical phenomenology and neurobiology of cocaine abstinence: a prospective inpatient study.

OBJECTIVE: This study was undertaken to document symptoms and changes in dopaminergic function emerging after abrupt cessation of cocaine use. METHOD: After admission, 22 patients with DSM-III-R cocaine dependence were observed drug free for 3 weeks. The patient-rated Ribicoff Abstinence Rating Scale, Symptom Rating Scale, Physical Symptom Scale, Patient Rated Anxiety Scale, Beck Depression Inventory, and visual analogue scales for 16 subjective states were completed daily, and nurses rated 13 patients with the global anxiety and depression items of the Short Clinical Rating Scale. Serial blood samples were obtained three times weekly, and the patients' levels of prolactin, growth hormone (GH), and homovanillic acid (HVA) were measured. Their prolactin and GH values were compared with those of matched normal subjects. RESULTS: A total of 62 subjective symptom variables were evaluated. At baseline, the symptom ratings were mildly elevated. At 3 weeks there were significant decreases from baseline in 28 variables and nearly significant decreases in six additional variables. Nurse-rated anxiety and depression also changed, but in a more variable pattern. There was a small but significant increase from baseline over time in plasma prolactin, but there were no significant changes in GH or HVA. The patients' prolactin and GH values did not differ from those of the normal subjects. CONCLUSIONS: These findings suggest that symptoms after inpatient cessation of uncomplicated cocaine addiction are relatively mild and decrease linearly over the first month. Evidence of dysregulated central dopamine function was limited. The findings do not support routine use of pharmacological agents in the inpatient management of such patients.

Adult↗
PubMed1991

Clinical features of cocaine-induced paranoia.

OBJECTIVE: The authors' objective was to assess the frequency and nature of cocaine-induced paranoia. METHOD: They interviewed 50 cocaine-dependent men consecutively admitted to a 28-day rehabilitation program. RESULTS: Thirty-four (68%) of the 50 men reported highly distressing transient paranoid states in the context of cocaine use. The men who experienced paranoia did not differ from those who did not in age, race, or measures of cocaine use. The mean duration and amount of cocaine use before development of paranoia of the men who reported paranoia were not significantly different from the mean lifetime duration and amount of cocaine used by the men who did not report paranoia. Paranoia became more severe and developed more rapidly with continued cocaine use. CONCLUSIONS: The transient paranoid state appears to be a common feature of cocaine dependence and does not seem to be simply a result of exceeding a threshold of use. Rather, affected individuals might possess a predisposition to this drug-induced state. The fact that paranoia became more severe and developed more rapidly with continued drug use is consistent with a sensitization model of cocaine-induced paranoia. In vulnerable individuals, limbic sensitization may underlie its expression, but localization to a specific brain region is speculative. Quantity of use and route of administration do not appear directly to predispose to this phenomenon. Future investigations must be aimed at uncovering the markers and meaning of vulnerability to transient paranoia in heavy cocaine users.

Adult↗
PubMed1990

Exploring the meanings of substance abuse: an important dimension of early work with borderline patients.

In this paper we encourage the evaluating clinician to approach substance abuse as though it were a symptom, like any other, that serves a psychological function for the borderline individual. During the assessment phase, this approach is likely to (1) generate interest among treaters (2) solidify rapport with the patient resulting in a positive attitude toward the assessing clinician with more informative self-reports, (3) elucidate, for the clinician, the patient's major deficits in personality structure, especially the inability to understand and control affective states, and (4) stimulate the patient's curiosity about the way in which emotions are perceived and processed.

Adult↗
PubMed1990

Mental status changes in children receiving glucocorticoids. Review of the literature.

Glucocorticoid preparations are used commonly in the treatment of many diseases in children and adolescents. Although their physiologic side of effects have been described well, the psychiatric side effects of these medications have received little attention. Limited data suggest that disturbances of affect and behavior may occur in 25-50% of children receiving glucocorticoid. These steroid-induced mental changes may be underrecognized in children, and yet these changes can have considerable impact on social and psychological functioning and treatment outcome. An enhanced awareness and reporting of this phenomenon by clinicians, parents, and teachers would likely lead to better compliance with treatment, improved outcomes, and greater understanding of emotional concomitants of illness.

Adolescent↗
PubMed1989

Migrainelike headache and cocaine use.

Migrainelike headache is a sequela of cocaine use. This finding expands the range of neurological complications of cocaine use and is consistent with the potential role of serotonin in the development of migraine. In these subjects, the desire to avoid the cocaine-induced headache eventually became part of the resolve to quit use.

Adult↗
PubMed1989

Seasonal cocaine abuse.

The authors describe two patients with seasonal affective disorder characterized by fluctuations in cocaine craving that paralleled seasonal dysphoria. This extends the range of axis I disorders associated with cocaine self-administration.

Adult↗
PubMed1989

Audiotape playback as a technique in the treatment of schizophrenic patients.

The authors report on the use of playing back audiotaped portions of the speech of two schizophrenic patients during psychotherapy. They believe that this audiotape replay was instrumental in organizing the patients' thoughts and spoken communications and that it might also have facilitated the patients' participation in psychotherapy. The usefulness of this strategy is illustrated with clinical material.

Adult↗
PubMed1989

Stimulants in the treatment of depression: a critical overview.

The authors reviewed the efficacy and safety of stimulant drugs in the treatment of depression. Although uncontrolled studies were generally positive, the 10 placebo-controlled studies of stimulant drugs in primary depression, with one exception, indicated little advantage of drug over placebo. Although several of these studies were methodologically unsophisticated, they were comparable with and performed during the same period as studies establishing the efficacy of imipramine. Controlled studies of stimulants in apathetic or depressed geriatric patients were more likely to be positive, but outcome frequently consisted of partial improvement. Studies in medically ill patients with depression were promising but uncontrolled. Side effects have not been severe, and these drugs may pose less of a risk than tricyclics in the medically ill or elderly. Habituation is suggested, but there are no placebo-controlled studies to confirm this. In short, the stimulant drugs do not appear to be as effective as the conventional antidepressants in primary depression, but may be of value in refractory cases or in special cases, such as those involving the medically ill patient. Placebo-controlled trials are needed to explore these questions.

Antidepressive Agents, Tricyclic↗
PubMed1985

Occurrence of high concentrations of postdexamethasone cortisol in elderly psychiatric inpatients.

The authors retrospectively studied 161 psychiatric inpatients who had received a dexamethasone suppression test (DST). The majority of the patients were over 60 years old, female, and had concurrent chronic medical illnesses. Age was significantly correlated with log-transformed postdexamethasone cortisol concentrations in the 118 nondemented patients with major depression. Four p.m. cortisol concentrations greater than 15 micrograms/dl occurred in 15 patients. All were over 60 years old; all but one had major depressive disorder (MDD); and five had dementia plus MDD. In the same population, a 5 micrograms/dl criterion did not distinguish MDD from non-MDD patients. The results support the existence of a clinically relevant age effect on the DST in patients with MDD. Elderly depressed patients with markedly elevated cortisol concentrations occur frequently, and warrant further clinical and pathophysiological study.

Adolescent↗
PubMed1985

Age, medical illness, and the DST in depressed general hospital inpatients.

A dexamethasone suppression test (DST) was administered to 89 general hospital inpatients as part of an evaluation of depressed mood. Among the 55 patients with major depressive disorder (MDD), age was positively correlated with postdexamethasone cortisol (r=.317, p=.002 at 4 p.m.). The patients without MDD did not show this effect. Postdexamethasone cortisol concentrations of 15 micrograms/dl or greater were seen in 31% of 32 patients over 60 with MDD; they did not occur in 23 patients under 60 with MDD. The results suggest a clinically relevant effect of age on the DST in patients with MDD.

Adolescent↗
PubMed1982

Resistance of the shell membrane and mineral layer to diffusion of oxygen and water in flexible-shelled eggs of the snapping turtle (Chelydra serpentina).

At oviposition, flexible eggshells of many turtles have an outer mineral layer and an inner membrane layer of approximately equal thickness. We measured conductances of both layers to H2O and O2 at various levels of eggshell hydration. Both the mineral layer of the eggshell and the shell membrane offer significant resistance to diffusion of water vapor and oxygen in eggshells of the snapping turtle, Chelydra serpentina. Conductance to water vapor increases in both the membrane and mineral layer with increasing hydration of the eggshell, but conductance to oxygen decreases under similar conditions. Removal of the mineral layer increases conductance to oxygen in moist and dry eggshells, but decreases conductance at intermediate levels of dehydration. Removal of the mineral layer consistently increases conductance to water vapor. The eggshell membrane accounts for 24-76% of overall resistance to diffusion of water vapor. These results suggest that bulk flow of H2O or physical changes in the shell may interact with diffusion to limit gas exchange through the turtle eggshell.

Animals↗