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Biomedical subjects

T R Price

Publications and source records attributed to T R Price.

At least 127 records · Page 7Linked to original sources
PubMed1986

Response of depressed patients to sequential unilateral nondominant brief-pulse and bilateral sinusoidal ECT.

Of 37 endogenously depressed patients given a course of unilateral nondominant brief-pulse ECT, 20 responded well and received no further treatment; 17 showed minimal clinical improvement but improved significantly after a subsequent course of bilateral sinusoidal ECT. These findings suggest that there may be subgroups of depressed patients who respond differentially to unilateral and bilateral ECT, to high- and low-energy stimuli, or to combinations thereof. Seizure duration did not appear to be a crucial variable in the efficacy of ECT; among the unilateral nonresponders, seizures of equal duration induced by unilateral stimulation were not as therapeutically effective as those induced by bilateral ECT. Response to the first three ECTs appeared to be the only predictor of unilateral responsiveness.

Adult↗
PubMed1985

Interobserver variability in the assessment of neurologic history and examination in the Stroke Data Bank.

Interobserver reliability in obtaining neurologic histories and examinations was investigated among neurologists collaborating in the Stroke Data Bank (SDB). Seventeen in-hospital stroke patients were examined by six neurologists experienced in stroke over the course of three days. Patients were examined twice a day for two successive days, with each patient seen by four different neurologists. Data were recorded on SDB forms, according to definitions and procedures established for the SDB. Percent agreement and kappa coefficients were calculated to assess the levels of agreement for each item. Important differences in levels of agreement were found among items on both neurologic history and examination. Agreement among neurologists was higher for neurologic examination than for history. Patterns of agreement for items with low prevalence or with numerous unknown ratings are discussed. Improvement in interobserver agreement due to data editing for intra-observer consistency was shown.

Adult↗
PubMed1985

A two-year longitudinal study of poststroke mood disorders. In-hospital prognostic factors associated with six-month outcome.

In a prospective study of mood disorders in stroke patients, variables obtained during the acute hospitalization were examined for their relationship to outcome at either 3- or 6-month follow-up. Distance of the lesion on computerized axial tomography scan from the frontal pole in patients with left anterior infarcts was significantly associated with severity of depression at 3 and 6 months poststroke. In addition, intellectual and functional physical impairment in-hospital were significantly correlated with severity of depression and social functioning scores at 3 and 6 months poststroke. Thus, patients who develop depression during the first 6 months poststroke may be responding to the severity of their impairment whereas the patients who develop depressions during the acute poststroke period may have a neuroanatomical and neurophysiological basis for their depression. Although other explanations might be proposed, the dynamic nature of the relationship between depression and associated variables during the first 6 months poststroke indicates that etiology of poststroke depression may be different depending upon the time of onset of the depression after brain injury.

Acute Disease↗
PubMed1985

Mood disorders in left-handed stroke patients.

Thirty left-handed patients hospitalized for stroke were examined for mood disorders. Patients with left hemisphere lesions and nondominant hand impairments had significantly higher depression scores and more depressive diagnoses than patients with right hemisphere lesions and dominant hand impairments. Major depression was strongly associated with left anterior brain injury, and depression severity was significantly correlated with proximity of the lesion on CAT scan to the left frontal pole. These findings are almost identical to previously reported results from right-handed patients and suggest that cerebral lateralization of poststroke mood disorders may be independent of cerebral motor dominance and language dominance.

Aphasia↗
PubMed1985

The dexamethasone suppression test and mood following stroke.

Dexamethasone suppression tests (DSTs) were given to 65 acute and chronic stroke patients. For patients who had had a stroke less than 1 year earlier, nonsuppression on the DST was significantly associated with the presence of poststroke depression. The authors, who used the DSM-III symptom criteria for major depression, found that DST sensitivity was 67% but specificity was only 70%. False positive tests in the stroke patients seemed related to large lesion volume. The DST, although of limited clinical utility in this population because of false positive tests, may help define more homogeneous subtypes of poststroke depression for research.

Aged↗
PubMed1985

Social functioning assessment in stroke patients.

The influence of depression, intellectual function, and physical impairment on patient reports of social functioning was assessed by comparing responses obtained from 30 stroke patients with those obtained from an outside informant who knew the patient well. There was relatively good agreement between patient and other for both the overall score on the Social Functioning Examination (SFE) and individual items related to specific aspects of social functioning. Differences between scores obtained from a patient and outside informant were not significantly related to either depression, moderate degrees of intellectual impairment, relative closeness of patient and informant or to degree of physical impairment. These data suggest that valid SF assessments can be made either by a stroke patient who is capable of being interviewed or by a familiar outside informant. In addition, the prognostic utility of the SFE was examined by interviewing 50 patients during the acute stroke period and following them over six months. Social functioning in-hospital scores were not found significantly related to 6-month scores for either depression, intellectual impairment, or physical impairment, but depression and in-hospital impairment significantly predicted social functioning at 6-month follow-up. These data suggest that the most impaired stroke patients are the most likely to undergo social deterioration during the post-stroke period and may require the greatest amount of social intervention. Whether treatment of these variables significantly affects 6-month outcome remains an intriguing question for further study.

Activities of Daily Living↗
PubMed1984

Nortriptyline treatment of post-stroke depression: a double-blind study.

The efficacy of nortriptyline in the treatment of post-stroke depression was assessed by a double-blind study in thirty-four patients. Half of the patients had major depression. There was a significantly greater improvement in depression in patients treated with nortriptyline than in a similar group of placebo-treated patients. Depression was measured by the Hamilton depression scale, Zung depression scale, present state examination, and an overall depression scale. Successfully treated patients had serum nortriptyline levels in the therapeutic range. Post-stroke depressions are common, severe, and longstanding, and the demonstrated efficacy of nortriptyline provides an important addition to the treatments available for stroke patients.

Brain↗
PubMed1984

Computer-aided assessment of transient ischemic attacks. A clinical evaluation.

We developed and evaluated a computer-based system to assist with the difficult problem of assessing the conditions of patients with transient ischemic attacks (TIAs). The program used criteria to classify a patient's illness localize the neurologic deficit, screen for 46 causative or mimicking disorders, recommend additional tests, and suggest management steps. We evaluated this program in 103 patients with TIAs. The TIA program's localization and classification of patients generally agreed with those made by stroke specialists at our institution, demonstrating that computer programs can reproduce the decision criteria of stroke specialists. With revisions, the TIA program or similar systems could be useful for objective disease classification in clinical trials or epidemiologic studies. In contrast, the TIA program's treatment recommendations were often found to differ significantly from the actual treatments administered by non-stroke specialists.

Computers↗
PubMed1984

Mood disorders in stroke patients. Importance of location of lesion.

In a selected group of right-handed patients with single stroke lesions of either the right (n = 14) or left (n = 22) hemisphere and no predisposing factors for psychiatric disorder, we found that the severity of depression was significantly increased in patients with left anterior lesions as opposed to any other lesion location. In addition, the severity of depression correlated significantly with proximity of the lesion on CT scan to the frontal pole in the left anterior group. The right hemisphere lesion group showed the reverse trend: patients with right posterior lesions were more depressed than patients with right anterior lesions, who were unduly cheerful and apathetic. These findings suggest that intrahemispheric lesion location is in some way related to mood disorder in stroke patients and that there is a graded effect of lesion location on severity of mood change. The neuroanatomy of the biogenic amine-containing pathways in the cerebral cortex might explain this graded effect and provide a neurochemical basis for the mood change.

Aphasia↗
PubMed1984

Volitional disability and physician attitudes toward noncompliance.

We develop the concept of a volitional disability as an aid in understanding those patients who behave in ways that are harmful to themselves in spite of their desire to do otherwise. Using this concept enables us to describe their behavior as intentional but 'involuntary'. We demonstrate the clinical reality of such behavior by giving clinical examples of the behavior of those with phobic, compulsive, and addictive disorders. We then attempt to show how some kinds of self-harming behavior of noncompliant patients are similar to phobic and compulsive behavior. We propose use of the concept of volitional disability to make it easier for physicians to work with these noncompliant patients and thus to improve their ability to provide better care for them.

Adolescent↗
PubMed1984

A two year longitudinal study of mood disorders following stroke. Prevalence and duration at six months follow-up.

We are conducting a two year longitudinal study of mood disorders in a group of 103 stroke patients. During the first six month period following the stroke the prevalence of symptoms of major depression increased from 23 per cent to 34 per cent while the frequency of symptoms of dysthymic depression increased from 20 per cent to 26 per cent. In addition, 10 of 13 patients who had major depressive symptoms during the initial evaluation continued to have these symptoms at six months follow-up and 4 of 9 patients who had minor depression in hospital developed major depression, while 5 of 9 continued to have minor depressive symptoms. Thus, the duration of depression following stroke is more than six months and the prevalence of major depressive symptoms increases steadily for the first half year after a cerebral hemorrhage or ischemic lesion.

Adult↗
PubMed1984

Impediments to Alcohol Education.

Two major forces mitigate against alcoholism education within the medical school curriculum. One relates to the structure and organization of academic medicine with its emphasis on disease states and pathophysiology; sophisticated and technologically complex diagnostic and treatment modalities; and an acute illness, cure-oriented focus rather than a chronic illness, adaptational approach to illness. The second constellation of factors relates to the alcoholism field's failure to identify with other issues in medical education that similarly challenge the Flexnerian curriculum; the lack of a conceptual basis for defining the physician-alcoholism specialist in relation to other medical disciplines; the clinical treatment field's competing craft and professional orientations; and the absence of a scientific vocabulary suited to the existing biopsychosocial paradigms. It is suggested that these impediments could be overcome if the alcoholism field defined the model for managing chronic illness that is implicit in alcoholism treatment.

Alcoholism↗
PubMed1983

Reliability, validity, and clinical utility of the social functioning exam in the assessment of stroke patients.

Social functioning is an important variable in the rehabilitation of stroke patients. We have designed a 28 item semi-structured interview to measure social functioning and have used this instrument in 103 stroke patients in whom we were investigating the occurrence of mood disorders. The social functioning exam was demonstrated to have high interrater and test-retest reliability as well as good agreement with social functioning as measured by other instruments or clinical assessment. The utility of the measurement of social functioning in the assessment of post-stroke mood disorders was demonstrated by the significant correlation between severity of depression and the degree of dysfunction in social functioning six months after the acute stroke, as well as the significant difference in mean social functioning scores between non-depressed and depressed groups.

Adult↗
PubMed1983

Mood change following bilateral hemisphere brain injury.

Fifteen patients with bilateral hemisphere brain injury secondary to thromboembolic stroke or trauma were evaluated for depression, cognitive impairment, and functional physical impairment. Analysis of CT scans and standardized mood scales revealed that patients with left anterior brain injury were significantly more depressed than patients without such injury. Depression severity was directly and significantly correlated with left lesion proximity to the frontal pole. Left lesion age, lesion temporal sequence, right lesion location, cognitive impairment, and functional physical impairment did not significantly correlate with depression. Depressive symptomatology previously shown to be associated with single left frontal lobe lesions appeared to dominate post-brain injury psychopathology regardless of location or temporal sequence of other brain lesions.

Activities of Daily Living↗