Biomedical subjects
Publications and source records attributed to T J Goldschmidt.
A patient with a previously undescribed spontaneous arrhythmic vertical eye movement termed slow-upward ocular bobbing is reported. The patient had a one-and-a-half syndrome due to pontine infarction. A simplified scheme for describing the variations of ocular bobbing is proposed based on the velocity and direction of the initial eye movement.
The dexamethasone suppression test (DST) is being used clinically as a diagnostic laboratory test for depression. Drug histories collected from 336 psychiatric inpatients revealed that 60% were taking one or more drugs suspected of altering DST results in either a false-positive or false-negative manner. Practical limitations of the DST as a biologic marker of affective syndromes in relation to patient drug use are discussed.
Psychotic patients who also have endogenous depressive symptoms often require treatment with several drugs (usually a neuroleptic-antidepressant combination) or electroconvulsive therapy. Loxapine is a neuroleptic of the dibenzoxazepine class; it is metabolized in vivo to desmethylloxapine (amoxapine) and 8-hydroxyamoxapine, two compounds with antidepressant activity. We traced the serum levels of total amoxapine (amoxapine plus 8-hydroxyamoxapine) in two treatment-resistant patients with psychotic-depression syndromes. One patient was treated with loxapine alone and the other with a loxapine-amoxapine combination. We also determined the total loxapine and amoxapine serum levels of ten patients treated at various dosages of loxapine alone. The results demonstrate that many patients treated with loxapine attain substantial serum levels of total amoxapine, some in concentrations thought to be therapeutic for nonpsychotic endogenous depression. We recommend further studies to determine the efficacy of loxapine in the management of treatment-resistant patients with psychotic-depression syndromes.
We evaluated 100 primary care outpatients for signs of cognitive impairment using the Mini-Mental State Examination (MMSE). The 23 subjects scoring abnormal values (less than 24/30) were found to be cognitively impaired. Seventeen had previously undetected cognitive impairment, while six had prior diagnoses consistent with cognitive impairment. Independent psychiatric evaluation identified these 23 outpatients as cognitively impaired, confirming the MMSE as a reliable, rapid instrument for cognitive assessment.
Primary degenerative dementia (Alzheimer's disease) is characterized by intellectual decline with impairment of memory, judgment, and abstract thinking. Also common are personality changes and disturbances of higher cortical function such as aphasia, apraxia, and agnosia. Standardized brief cognitive tests are useful for evaluating mental status, which is often limited by short attention span, distractibility, fatigability, mental retardation, illiteracy, and/or confusion. Data from 225 institutionalized patients support the mini-object test (MOT) as a valid, reliable, cost-effective, portable screening procedure for confirming the clinical diagnosis of aphasia-apraxia-agnosia associated with senile dementia of the Alzheimer type. Further studies are needed to demonstrate the diagnostic value of the MOT in other dementing disorders.
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Holmes, et al. in 1979 compiled 125 studies in a bibliography of behavioral science in undergraduate and graduate education. Since 1979, 75 additional studies of behavioral science in medical education have been identified. The current updated bibliography contains 200 entries. Foreign medical journals, Index Medicus, and Psychological Abstracts were reference sources for the bibliography.
Since 1956, there have appeared 125 studies which focus on the issue of integrating behavioral science into undergraduate and graduate medical education.
Depression is a significant problem in the elderly population and is often accompanied by cognitive changes and agitation. Hypothalamic-pituitary axis dysfunction may occur in some depressed elderly patients and represent a non-specific physiological hyperarousal state. Moreover, recent evidence confirms that antidepressants down-regulate beta-adrenergic receptors in the central nervous system. These findings provide the background for proposing that depression may result from an age-specific, stress-induced dysfunction of the beta-adrenergic receptor system in a subgroup of the geriatric population. A bio-psycho-social model for understanding and developing innovative treatment strategies for depression in the elderly is presented.