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Biomedical subjects

T J Craig

Publications and source records attributed to T J Craig.

At least 55 records · Page 3Linked to original sources
PubMed1996

Elevation of creatine kinase from skeletal muscle associated with inhaled albuterol.

BACKGROUND: Elevations of creatine kinase have been described, but have been associated with high doses of albuterol given by oral or intravenous routes. Most reports have described an elevation of MB isoenzyme fraction from the heart. Elevation of creatine kinase-MM isoenzyme from skeletal muscle rarely appears to be associated with the use of inhaled albuterol. OBJECTIVE: A patient is discussed who presented with severe myalgias and was found to have elevated creatine kinase-MM from albuterol metered dose inhaler. METHODS: Clinical status, creatine kinase levels, electromyography, enzyme stains, histopathologic and lactate challenge studies were done to evaluate the status of the patient. RESULTS: Without exercise or use of albuterol, creatine kinase-MM levels were normal. With the use of albuterol, whether inhaled or by oral therapy, the creatine kinase-MM level increased. When combined with exercise, higher levels occurred. Workup was normal except histopathology revealed a myopathy. CONCLUSION: Patients with myalgias from albuterol with elevated creatine kinase-MM fraction should be investigated for possible myopathy.

Administration, Inhalation↗
PubMed1996

Neuroleptics in acute mania: a pharmacoepidemiologic study.

OBJECTIVE: To provide an epidemiologic descriptive analysis of the acute drug treatment of inpatients with bipolar mania in state psychiatric facilities in 1990. METHODS: We surveyed the first 3 weeks of drug treatment of all inpatients with bipolar mania who were admitted to 22 New York State adult psychiatric facilities during a 6-month period (n = 528). RESULTS: Almost all patients with mania were treated with neuroleptics. The mean +/- SD neuroleptic dosage was 684 +/- 543 mg/d chlorpromazine equivalents. Sixty-one percent of the patients received lithium and 12% received carbamazepine or valproate. Neuroleptic dosage was related to age, with older patients receiving lower dosages. Patients receiving combination treatment of a neuroleptic with either lithium, an anticonvulsant, or a benzodiazepine received a mean neuroleptic dosage similar to that of patients treated with a neuroleptic alone. CONCLUSIONS: Although their use has been widely discouraged for mood disorders, neuroleptics have been the standard treatment for acute mania.

Adult↗
PubMed1996

Admission criteria for inpatient substance abuse/dependence rehabilitation: implications for managed care.

In view of recent trends toward the replacement of traditional inpatient rehabilitation programs with nonresidential services, we examined the extent to which patients currently admitted to inpatient rehabilitation for alcohol or drug abuse/dependence met published criteria suggesting a preferential need for inpatient or residential care. Over 90% of almost 300 veterans with a primary DSM-III R diagnosis of alcohol or substance abuse/dependence, admitted to six New York Metropolitan Area Veterans Administration Medical Centers for inpatient rehabilitation, met at least one criterion dimension considered indicative of a need for such services, with over two-thirds meeting two or more dimensions. These findings suggest a continuing need for initial primary inpatient or residential rehabilitation for such patients.

Adult↗
PubMed1996

Assessment of care of patients with asthma in a family practice training program.

To determine if primary care physicians have been adhering to guidelines set forth by the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel Report Guidelines for the Diagnosis and Management of Asthma, the author gauged the use of peak flow meters in a hospital family training program. Specifically investigated were the physicians' response to results from the peak flow meters and their prescribing practices regarding the beclomethasone dipropionate metered-dose inhaler. Overall, the use of peak flow meters among the 20 patients included in this study averaged 70%, up from 10% in earlier studies. Similarly, 45% of these patients received prescriptions for beclomethasone metered-dose inhalers with spacer devices. Although these results appear to indicate that physicians are following the aforementioned guidelines, the author cautions that the peak expiratory flow rate measurement is not a perfect indication of asthma severity. Likewise, the spacer devices are not indicated for all patients with asthma who are taking inhaled corticosteroids. Finally, the author emphasizes that anti-inflammatory agents should be effectively used when indicated.

Asthma↗
PubMed1996

Use of astemizole in a large group practice.

Astemizole was released in 1988. In late 1992, a new warning label was added in response to reports of syncope and death from arrhythmia. Records of patients given new prescriptions for astemizole were reviewed to assess compliance with the warnings in a large multispecialty practice. The indication was appropriate in 89% of cases. Excessive doses were used in 4% of cases. Two percent of prescriptions were given to patients with contraindications. Only two complications were documented. Despite carrying a drug warning, astemizole continues to be used inappropriately and is a medicolegal concern. Education and drug evaluations can be used to enhance compliance and decrease the risk associated with the use of astemizole.

Arrhythmias, Cardiac↗
PubMed1996

Assessment of insight in psychotic disorders.

This paper presents a selected review of the concept insight as regards recognition of the presence of illness among patients with psychotic disorders in general and with schizophrenia in particular and the development of new instruments for its assessment. Lack of insight appears to be a common pathway for different psychopathological processes and may have different meanings in different stages of the illness. Three major dimensions of the concept include: (1) awareness of having a mental illness; (2) the need for treatment; and (3) relabeling symptoms and signs as pathological and attributed to a mental illness. This complexity must be addressed by studies with a design using instruments which are appropriate to the research goals and carefully identify the stage of illness of the target population.

Awareness↗
PubMed1995

Hiccups due to gastroesophageal reflux.

Hiccups (singultus) are most often a transient phenomenon that resolves without medical therapy. Intractable hiccups can be an indication of a serious underlying disease process and should be investigated. To demonstrate the evaluation of intractable singultus, we describe a patient who had unsuccessful outpatient therapy for persistent hiccups and who was subsequently found to have gastroesophageal reflux (GER). Efforts to determine the cause of the hiccups were negative except for endoscopically proven GER. On follow-up visits, antisingultus medications were withdrawn without return of hiccups, and repeat endoscopy showed substantial healing of the esophagitis. We conclude that GER may be underestimated as a cause of hiccups.

Adult↗
PubMed1995

Interrater and observer/self-report correlation of psychopathology in routine clinical practice.

Interrater (attending vs resident) and observer/patient self-report correlations were assessed for 17 and 9 symptom factors, respectively, in a consecutive sample of psychiatric outpatients at the time of intake evaluation in a university based clinic using the Hopkins Psychiatric Rating Scale (HPRS) and the SCL-90R. Highly significant interrater reliability was obtained for most items on the HPRS but observer/self-report correlations were more variable, ranging from good (r = .60 to .75) for depression and phobic anxiety, to poor (r < .40) for obsessive-compulsive, paranoia, and psychoticism symptoms. Results also varied by patient sex. The findings suggest a role for both observer and, for specific symptoms, self-report symptom scales in routine clinical practice.

Ambulatory Care↗
PubMed1995

An epidemiologic study of prn/stat medication use in a state psychiatric hospital.

The prevalence of prn/stat psychotropic medication administration and the characteristics and concomitants of high use of these medications were examined via a retrospective medical record review in a 973-bed state hospital. While 22.9% of the total hospital population received at least 1 prn/stat dose during the study month, 27 patients (2.8% of the total population) received 44.4% of the prn/stat doses, averaging 9.7 doses per patient. Examination of high-prn/stat use patients whose disruptive behavior and prn/stat use was "intermittent" throughout the month (N = 16) vs those who exhibited these characteristic for only a "discrete period" with resolution (N = 11) suggested that the prescription of antipsychotic drugs as prn/stat doses as well as increases in or institution of these medications was significantly associated with the latter group's resolution of disruptive behavior. The findings suggest the need for clinical protocols as guides for clinicians in the establishment of effective pharmacotherapy for patients with agitated, threatening behavior, including the use of plasma levels to ensure adequate dosage of psychotropic medication.

Dose-Response Relationship, Drug↗
PubMed1995

A case-control study of rapid readmission in a state hospital population.

A case-control comparison of clinical and service system characteristics among chronic psychiatric patients with rapid readmission (within 90 days of discharge), patients with readmission after more than 90 days of community tenure, and nonreadmitted patients revealed several clinical variables (e.g., medication noncompliance, substance abuse, and disruptive behavior) to be associated with readmission regardless of community tenure. In contrast, two service system variables (discharge to a structured outpatient treatment program and adequacy of discharge planning) were more highly associated with rapid readmission than the other conditions, while availability of case management had no association with readmission, rapid or otherwise.

Adult↗
PubMed1995

Medication treatment in first-admission patients with psychotic affective disorders: preliminary findings on research-facility diagnostic agreement and rehospitalization.

The discharge medications of 101 Suffolk County subjects with facility and/or research diagnoses of affective disorder were ascertained. Rehospitalization was recorded for a 6-month follow-up period. Twenty-three of 31 patients (74.2%) with a facility diagnosis of depressive disorder were prescribed antidepressants, and 21 of 36 patients with a facility diagnosis of bipolar disorder (58.3%) were prescribed lithium. When research and facility diagnoses concurred, 84.2% of depressed patients were prescribed antidepressants, and 66.7% of bipolars were given lithium. The percentages were lower when the two diagnoses were discrepant. The results for diagnostic congruence were independent of demographic variables, length of stay, and premorbid functioning. Patients prescribed diagnosis-specific medications had a lower rate of rehospitalization (7.3%) than those not prescribed such medications (22.2%). The findings suggest that such medications are prescribed in the more unambiguous cases of affective disorders and are important (with or without antipsychotic treatment) in preventing rehospitalization.

Adolescent↗
PubMed1995

Tannic acid's effect on bird antigen.

BACKGROUND: Birds have been associated with many diseases including hypersensitivity pneumonitis and allergic diseases such as asthma and rhinitis. Bird antigen from homes of patients with hypersensitivity pneumonitis persists long after the bird is removed from the home. This may account for the persistence of symptoms, signs, and bird-specific IgG in patients with hypersensitivity pneumonitis. Tannic acid application has been effective in decreasing cat and mite allergen levels. No data have been available on tannic acid's effect on bird antigen. OBJECTIVE: It is the purpose of this study to determine whether tannic acid reduces bird antigen in the home. METHOD: Dust samples were collected from homes with bird antigen before and after application of tannic acid. Samples were assayed for bird antigen levels using a competitive inhibition ELISA. Pre- and post-bird antigen levels were compared using a paired t test to determine whether antigen was reduced significantly. RESULTS: There was not a statistical difference between bird antigen levels before and after application of tannic acid as compared by paired t test (P = .09). CONCLUSION: Tannic acid is not effective in decreasing bird antigen levels. In patients with hypersensitivity pneumonitis or allergic disease to birds, the bird should be removed from the home and environmental cleanup should be undertaken, but tannic acid application is not indicated.

Allergens↗
PubMed1994

Comparison of facility and research diagnoses in first-admission psychotic patients.

OBJECTIVE: The present study investigated the concordance of clinical and research-based DSM-III-R diagnoses in community, public, and university hospital first-admission patients. In addition to demographic characteristics, information and criterion variance were assessed as explanations for the diagnostic disagreements. METHOD: As part of the Suffolk County (New York) Mental Health Project, 223 first-admission subjects with a psychotic disorder were interviewed with the Structured Clinical Interview for DSM-III-R, and consensus diagnosis was made by two project psychiatrists. Clinical diagnoses were abstracted from discharge summaries obtained subsequent to the research diagnoses, and reasons for disagreement between the two diagnoses were determined. RESULTS: Moderate overall agreement between facility and research diagnoses was found, with highest agreement with the university facility, lowest with the public facilities, and intermediate agreement with the community facilities. Demographic variables were not significantly associated with diagnostic discordance. Apparent reasons for diagnostic disagreement included evidence of variability in information available to clinicians and research psychiatrists (N = 39 or 48% of cases with disagreement), as well as in clinical judgment in the application of DSM-III-R criteria (N = 42 or 52% of cases with disagreement). CONCLUSIONS: Considerable differences between facility and research diagnoses remain, especially in the public and community sectors; these differences can be attributed to information and criterion variance. Longitudinal follow-up is necessary to establish the predictive validity of the initial clinical and research diagnoses. Future research should also address other possible reasons for these discrepancies.

Adult↗
PubMed1993

Pharmacoepidemiology of clozapine in 202 inpatients with schizophrenia.

OBJECTIVE: To evaluate clozapine in a field trial for hospitalized patients with treatment-resistant schizophrenia. METHOD: The setting consisted of a large, state-operated, public psychiatric system. The protocol called for the treating psychiatrist to provide symptom- and adverse-effect ratings at four times following the start of drug therapy. The outcome criteria included the Sandoz study outcome measure of symptom improvement as well as discharge status for one year of follow-up. To assess the validity of the ratings, several measures of internal consistency were determined. Clozapine therapy was started in 227 patients, and symptom data are available for 202. RESULTS: Overall, 33 percent (n = 66) of the patients were improved at the end of one year of treatment; 12 percent (n = 24) maintained symptom improvement at all three evaluation times. Modest, statistically significant improvement after 12 weeks compared with baseline Brief Psychiatric Rating Scale (BPRS) total scores was observed for the patients continuing medication (n = 152); the emergence of a previously unimproved group (n = 26) explains this modest improvement. However, in the analysis of all patients (n = 202), (including dropouts), there was no significant symptom improvement after 12 weeks. Lower baseline BPRS scores predicted significant symptom improvement after 12 weeks of treatment. Among those medicated for one year, the pattern of symptom improvement showed that the probability of late improvement was 0.26 for those previously unimproved, and the probability of a 12-week responder losing improvement was 0.23, resulting in a net group gain of 3 cases in 100. By the end of one year, 8 percent (n = 17) of the cohort was discharged, and 3 percent (n = 7) was transferred to another facility while continuing to receive clozapine. Of the 227 original patients started on clozapine therapy, medication was discontinued for adverse effects in 11 percent (n = 25): white blood cell count (WBC) decrease (but no agranulocytosis) in 5 percent (n = 12), seizures in 1 percent (n = 3), one patient with seizures and decreased WBC count, and other events (e.g., cardiovascular changes, fever, or possible neuroleptic malignant syndrome) in 4 percent (n = 9). Patient refusal was reported for 6 percent (n = 13) of those starting treatment. CONCLUSIONS: Although only 19 percent of the patients exhibited improvement at 6 weeks, the response rate at 12 weeks (29 percent) for this naturalistic study cohort was similar to that in the major, double-blind, six-week, controlled, clinical trial of clozapine. The impersistence of response as symptoms were followed for up to one year is a finding that deserves rigorous evaluation.

Adult↗