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Biomedical subjects

W Breitbart

Publications and source records attributed to W Breitbart.

63 records · Page 4Linked to original sources
PubMed1989

Psychotropic adjuvant analgesic drugs for cancer pain.

Narcotic analgesics are the mainstay of pharmacological interventions for cancer pain. There is however growing awareness that psychotropic drugs, in particular the antidepressants, are useful adjuvant analgesic agents in the management of cancer pain. In addition many of these drugs are important in the treatment of psychiatric complications of cancer. Unfortunately cancer patients with pain are most vulnerable to such problems as depression, anxiety and delirium. For the clinician who wants to provide comprehensive management of cancer pain, familiarity with the indications and usefulness of psychotropic drugs will be most rewarding.

Adjuvants, Pharmaceutic↗
PubMed1988

Psychosocial aspects of head and neck cancer.

The major psychosocial issues in managing the patient with a head and neck tumor are dealing with the emotional reactions to structural and functional deficits, recognizing and treating preexisting personality problems, especially those related to alcohol and tobacco abuse, which frequently complicate their treatment course. These factors influence the rehabilitation process which should begin in the preoperative period with careful attention to psychologic and social assessment and psychiatric evaluation; if an alcoholic history is elicited. Important continuity in rehabilitation can be accomplished by contact with the rehabilitative team members before surgery, preoperative chemotherapy or radiation. Attention to appropriate adaptation to facial prostheses and dealing early with communication disorders requires a specialized staff and a rehabilitative team which can call on a range of skills including a psychiatric consultant. While the ordeal of the head and neck cancer patient is psychologically difficult and challenging, most patients are able, with the proper help, to resume full and productive lives.

Alcoholism↗
PubMed1987

Suicide in cancer patients.

Identifying the cancer patient who is at increased risk for suicide is the first step in prevention, and allows for appropriate psychosocial interventions to be initiated. The author presents a list of vulnerability factors that contribute to high suicide potential.

Aged↗
PubMedDate not supplied

Psychotropic adjuvant analgesics for pain in cancer and AIDS.

The 'WHO Analgesic Ladder' is a well validated approach for the selection of appropriate analgesic therapy for cancer pain as well as pain in AIDS. The mainstay of analgesic intervention for cancer and AIDS pain of moderate to severe intensity continues to be the appropriate use of opioid analgesics. There is, however, a growing appreciation for the role of adjuvant analgesics, such as antidepressants and other psychotropic medications, at each step of the WHO Analgesic Ladder, particularly in the treatment of neuropathic pain. Knowledge of the indications and usefulness of psychotropic analgesic drugs in cancer and AIDS pain populations will be most important to clinicians practicing in psycho-oncology/AIDS settings, particularly since these drugs are useful not only in the treatment of psychiatric complications of cancer and AIDS, but also as adjuvant analgesic agents in the management of pain. This paper reviews the literature on the use of antidepressants, psychostimulants, neuroleptics, anticonvulsants and other psychotropic analgesics in the management of cancer and AIDS pain. Mechanisms of analgesia, drug selection, and recommendations for clinical usage are discussed. The appropriate and timely use of psychotropic adjuvant analgesic drugs represents an opportunity for active psychiatric contribution to the multidisciplinary management of cancer and AIDS pain.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The undertreatment of pain in ambulatory AIDS patients.

Pain is highly prevalent in individuals with HIV disease, yet is often overlooked as a symptom requiring clinical intervention. We evaluated the adequacy of analgesic management for pain and identified predictors of pain undertreatment in a sample of 366 ambulatory AIDS patients using a prospective cross-sectional survey design. Two hundred and twenty-six of the 366 ambulatory AIDS patients surveyed reported "persistent or frequent" pain over the 2 week period prior to the survey. Adequacy of analgesic therapy was assessed using the Pain Management Index (PMI - a measure derived from the Brief Pain Inventory) and the type and frequency of analgesic medications prescribed for pain. Results indicated that nearly 85% of patients were classified as receiving inadequate analgesic therapy based on the PMI. Less that 8% of the 110 patients who reported "severe" pain were prescribed a "strong" opioid (e.g., morphine), as suggested by published guidelines. Adjuvant analgesic drugs (e.g., antidepressant medications) were prescribed in only 10% of the patients. Women, less educated patients, and patients who reported injection drug use as their HIV transmission risk factor were most likely to have received inadequate analgesic therapy. These results demonstrate the alarming degree of undertreatment of pain in ambulatory patients with AIDS, and indicates the need to improve the management of AIDS-related pain in this underserved population. Future research should elucidate the factors that impede adequate pain management in order to overcome obstacles to adequate treatment.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Pain management and psychosocial issues in HIV and AIDS.

My goal for this presentation is to provide an overview of the pain experience of patients with AIDS, including focuses on prevalence, common syndromes, and factors that contribute to undertreatment. As a means to dramatize the impact of pain on quality of life, we'll discuss excerpts from a videotape of one of my patients who eloquently expresses the difficulty he had in getting effective pain treatment, and the impact if finally made. Finally, we'll discuss basic management principles, largely adapted from those developed over the past decades for cancer pain, with a special emphasis on issues related to the management of pain in AIDS patients who have a history of substance abuse.

HIV Infections↗