Showing papers in "International Journal of Psychiatry in Medicine in 1989"
TL;DR: The agreement of the Beck Depression Inventory (BDI) with DSM-III diagnoses of depression in a sample of renal dialysis subjects was examined and higher BDI threshold levels decreased the sensitivity of the measure but did not produce a clinically meaningful increase in the positive predictive value.
Abstract: Self-report measures of depressive symptoms have been frequently employed in medically ill samples despite the lack of information regarding their psychometric properties in these subjects. We have examined the agreement of the Beck Depression Inventory (BDI) with DSM-III diagnoses of depression in a sample of renal dialysis subjects (n = 99). A threshold of greater than or equal to 15 on the BDI produced optimal sensitivity (.92), negative predictive value (.99), and maximized Youden's index of validity (.72) for the use of the BDI as a screening device for depressive syndromes in dialysis patients. Higher BDI threshold levels decreased the sensitivity of the measure but did not produce a clinically meaningful increase in the positive predictive value.
247 citations
TL;DR: In support of the hypothesis that sense of humor moderates immunosuppressive effects of stress, hierarchical multiple regression analyses revealed significant moderating effects of three of the four humor measures on this relationship between hassles and S-IgA.
Abstract: This study was designed to investigate whether sense of humor moderates immunosuppressive effects of stress. At two time periods one and one-half months apart, forty subjects completed the Daily Hassles Scale and provided saliva samples for determining secretory immunoglobulin A (S-IgA) levels. Four scales were used to assess different aspects of the sense of humor. A negative correlation was obtained between frequency of hassles at time 1 and S-IgA levels at time 2 (r = -.32, p less than .05), suggesting an immunosuppressive effect of hassles. In support of our hypothesis, hierarchical multiple regression analyses revealed significant moderating effects of three of the four humor measures on this relationship between hassles and S-IgA. Subjects with low scores on the humor scales revealed a stronger negative relationship between hassles and S-IgA than did those with high humor scores. These results are discussed in terms of other research examining psychological influences on immune function.
193 citations
TL;DR: At a cut-off point of 16, the CES-D was found to have a specificity of 90 percent, a sensitivity of 86 percent and a positive predictive value of 80 percent and thus may be a potentially useful screening instrument for post-stroke depression.
Abstract: The present study examines the sensitivity and specificity of the Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for post-stroke depression. Eighty stroke patients were evaluated by a research nurse over a two-year period using the CES-D and also by a trained psychiatrist using a standardized interview for affective, cognitive, physical and social functioning. CES-D scores correlated significantly with DSM-III diagnoses of depression in-hospital and at three months, six months, and one year follow-up but not at two years follow-up, reflecting the natural course of these depressions, as well as the predictive validity of the CES-D. Furthermore, at a cut-off point of 16, the CES-D was found to have a specificity of 90 percent, a sensitivity of 86 percent and a positive predictive value of 80 percent and thus may be a potentially useful screening instrument for post-stroke depression.
160 citations
TL;DR: Many reported symptoms often attributed to diabetes are more related to depressive mood than to a conventional clinical measure of blood glucose control, and may be unreliable indicators of poor metabolic control when features suggestive of depression are present.
Abstract: The relationship of diabetes symptoms to current mood and general metabolic control was studied. Symptoms commonly associated with poorly controlled diabetes (e.g., thirst, polyuria, weight loss) were measured in 114 patients with diabetes mellitus (type 1 = 57, type 2 = 57). Scores for these individual symptoms were correlated with glycosylated hemoglobin (HbA1) and depression as measured by the Beck Depression Inventory (BDI). HbA1 was poorly correlated (r less than 0.2) with nine of the eleven symptoms and made a significant independent contribution only to the reporting of polyuria (p = 0.04). In contrast, depression was moderately correlated with nine symptoms and had a significant effect on the reporting of two of three hyperglycemic symptoms, five of six hypoglycemic symptoms, and both nonspecific symptoms of poor control (p less than 0.05 for each). We conclude that many reported symptoms often attributed to diabetes are more related to depressive mood than to a conventional clinical measure of blood glucose control. Diabetes symptoms may be unreliable indicators of poor metabolic control when features suggestive of depression are present.
98 citations
TL;DR: The results showed that problems in concentration and memory were related to emotional distress, poor family support, and interference with daily activities.
Abstract: This study examined concentration and memory problems in chronic pain patients as they related to emotional distress and interference with daily activity. Three hundred and sixty-three chronic pain patients were divided into two groups based on how much they expressed difficulty in concentrating and remembering things. Each patient was given a physical examination and completed a pain evaluation questionnaire and an SCL-90. Physician ratings of the patients' depression and anxiety were also obtained. The results showed that problems in concentration and memory were related to emotional distress, poor family support, and interference with daily activities. It is suggested that techniques to improve concentration and memory should be incorporated as part of a multidisciplinary pain program.
93 citations
TL;DR: Low detection rate and less than adequate treatment may indicate a lack of sensitivity on the part of clinicians to depression in this population, and the reluctance to use antidepressants may be partly explained by the observation that 87 percent of depressed patients had relative or absolute contraindications to antidepressants.
Abstract: While major depression is common among medically ill older inpatients, little is known about the frequency of detection or appropriate treatment in this population. In the present study, 171 consecutive men age seventy and over admitted to the medical and neurological services of a VA medical center were screened for major depression. The medical records of all patients identified with this disorder were reviewed for documentation of depression by housestaff 1) prior to our evaluation and 2) throughout the rest of the hospital stay. Relative and absolute contraindications to antidepressant therapy were also sought. Of patients identified with major depression, 20 percent (3/15) had depressive symptoms documented in their charts by housestaff prior to our evaluation. After housestaff were informed of the possibility of major depression, 27 percent (4/15) of these patients eventually received psychiatric consultations, and 13 percent (2/15) had antidepressants initiated. At the time of discharge only 13 per...
85 citations
TL;DR: Results indicated that affective and anxiety disorders developed frequently, regardless of outcome of anorexia nervosa, and the symptomatic group had a significantly higher incidence of anxiety disorders prior to the development of their eating disorder compared with the asymptomatic group.
Abstract: This study investigated the incidence and onset of affective and anxiety disorders in women who were diagnosed with anorexia nervosa five to fourteen years earlier. Based on the clinical outcome of anorexia nervosa, patients were classified as asymptomatic, improved or symptomatic. Affective and anxiety disorders were assessed by a structured psychiatric interview (Diagnostic Interview Schedule). Results indicated that affective and anxiety disorders developed frequently, regardless of outcome of anorexia nervosa. Major depression and anxiety disorders developed before the eating disorder in one-half and three-quarters of these cases respectively. The symptomatic group had a significantly higher incidence of anxiety disorders prior to the development of their eating disorder compared with the asymptomatic group.
81 citations
TL;DR: Clinical case reports, clinical series, and a small number of controlled studies provide evidence that many commonly prescribed psychiatric drugs may have untoward effects on sexual function.
Abstract: Clinical case reports, clinical series, and a small number of controlled studies provide evidence that many commonly prescribed psychiatric drugs may have untoward effects on sexual function. Both heterocyclic antidepressants and monoamine oxidase inhibitors appear to be associated with ejaculatory impairment. Erectile dysfunction and retarded ejaculation have been associated with neuroleptics. Several benzodiazepines have been reported to interfere with ejaculation. This information has clear significance for the prescribing physician.
78 citations
TL;DR: It is suggested that depression and panic attacks in association with atypical chest pain may be underdiagnosed by the emergency room physician; and that self-report screening measures as an aid to diagnosis in this population need to be more closely investigated.
Abstract: In response to recent reports relating atypical chest pain to normal coronary arteries and to various types of psychopathology, we developed a pilot study to investigate 1) the prevalence of depres...
63 citations
TL;DR: The relationship between the CES-D and the ZUNG self-report depression scales was investigated in seventy-eight elderly people with osteoarthritis (mean age 71).
Abstract: Depression is one of the most common mental health problems in the elderly, but there is little consensus about the best way to assess depression in the aged. The relationship between the CES-D and the ZUNG self-report depression scales was investigated in seventy-eight elderly people with osteoarthritis (mean age 71). The correlation between the scales was r = .69, with the CES-D classifying 15 percent of the participants as depressed, as compared to 6 percent by the ZUNG. Psychological symptoms had the strongest relationship with overall depression scores on both scales. No sex differences were found on psychological items on either scale, but females reported more somatic symptoms on the ZUNG. People over age seventy-four reported more psychological symptoms than their younger counterparts.
51 citations
TL;DR: Although stroke lesion location is the strongest predictor of subsequent depression, there appears to be a reciprocal relationship between physical impairment and depression (i.e., depression predicts impairment and impairment predicts depression).
Abstract: In a prospective study of mood disorders in 103 stroke patients, we examined the predictive value of affective, cognitive, social and neurologic variables obtained in-hospital and at six months poststroke in terms of outcome as determined by the same measures at one and two years follow-up. The following factors were found to have prognostic significance: 1) Lesion Location: proximity of the lesion on CT scan to the frontal pole in patients with left anterior infarcts showed a strong positive relationship with severity of depression at one year but not at two years poststroke. 2) Affective Status: depression (in-hospital and at 6 months) strongly predicted depression at one year but not at two years poststroke. Additionally, in-hospital depression significantly correlated with physical impairment at two years, while depression at six months bore a moderate relationship to physical impairment at one year. 3) Physical Impairment: impairment in activities of daily living in-hospital bore a modest relationshi...
TL;DR: Results of this study question the earlier reports of the usefulness of amitriptyline in chronic muscle contraction headache and depression associated with minor closed head injury.
Abstract: The author compared the response to amitriptyline in headache associated with depression between twelve patients having primary depression (control group) and ten patients with depression after minor closed head injury. In the primary depression group, there was significant reduction in headache and improvement in depression. The minor closed head injury group did not show significant reduction in headache or improvement in depression. The latter group, upon further treatment with phenelzine also showed no reduction in headache or improvement in depression. Results of this study question the earlier reports of the usefulness of amitriptyline in chronic muscle contraction headache and depression associated with minor closed head injury.
TL;DR: It is suggested that denial serves as an adaptive mechanism, especially in the immediate postoperative period, and higher levels of denial may be predictive of improved psychologic outcome for up to six months following surgery.
Abstract: Using a modified version of the Hackett-Cassem denial scale we measured preoperative denial in 121 patients scheduled for CABG surgery. A significant inverse relationship was found between the denial scale and Hamilton Anxiety measures four days postoperatively (p < .02). Longitudinal assessments were carried out using the Spielberger State Anxiety Inventory (SSAI), the Zung Self-Rating Depression Scale (Zung SDS) and the Psychosocial Adjustment to Illness Scale (PAIS). Six months following the surgery, significant negative relationships between denial and these self-report outcome measures were observed as follows: denial and SSAI (p < .001), denial and Zung SDS (p < .01), and denial and PAIS (p < .01). However, the same analysis at twelve months showed no statistically significant correlations between denial and these psychologic outcome measures. Our findings suggest that denial serves as an adaptive mechanism, especially in the immediate postoperative period. Furthermore, higher levels of denial may b...
TL;DR: Nonspecific, supportive psychiatric consultations were performed with a random sample of general medical inpatients scoring thirteen or more on the Beck Depression Inventory, and a significant reduction in other medical care expenditures and in length of hospital stay could not be demonstrated.
Abstract: Nonspecific, supportive psychiatric consultations were performed with a random sample of thirty-three general medical inpatients scoring thirteen or more on the Beck Depression Inventory. The control group consisted of thirty-five patients, matched for sex, marital status, somatic history, and seriousness of illness. The number of patients receiving no analgesic and/or psychotropic medication in the consult group (39%) was significantly greater than that in the control group (17%). When compared with their mean BDI score on admission, the BDI score just before discharge had decreased significantly in the consult group (from 20 to 13), but not in the control group (from 19 to 16). Probably because the patient sample was too heterogeneous, with too low a prevalence of mental disorders (45%), a significant reduction in other medical care expenditures and in length of hospital stay could not be demonstrated.
TL;DR: Unexpectedly, physicians were not found to assume an appropriately active or comprehensive mental health role in their practices following the training intervention, which underscores shortcomings of present psychiatric nosology when applied in the general medical setting.
Abstract: It is well documented that primary care physicians encounter many patients in their practices who suffer psychiatric morbidity, especially affective, anxiety and substance abuse disorders. These physicians have been unable to effectively address the needs of these patients, over half of whom receive care exclusively in the primary care sector. Five years after implementing a curriculum to train family practice physicians to assume a comprehensive psychiatric role with patients in their practices, the authors undertook an outcome evaluation. The focus was on psychiatric disorder recognition, diagnosis, documentation, and management, including referral. It was hoped that biopsychosocial and community mental health orientations emphasized during training would be incorporated into the subsequent primary care practices of physicians in the study. In the research design, physician-generated diagnoses were compared with DIS/DSM-III diagnoses; physician interviews and chart audits enabled processes of care delivery to be evaluated. Unexpectedly, physicians were not found to assume an appropriately active or comprehensive mental health role in their practices following the training intervention. Of ninety-four DIS-generated diagnoses in the study population of fifty-one patients, 79 percent were unrecognized. Patients were assumed to function well emotionally, and psychiatric dimensions of patient complaints were not examined in the majority of cases. The physicians did diagnose and treat a number of patients with mental symptoms who were not identified by the DIS. These patients had high, but sub-diagnostic, DIS symptom counts. Most received a diagnosis of adjustment disorder in response to medical illness. Though this finding underscores shortcomings of present psychiatric nosology when applied in the general medical setting, the foremost consideration was the large number of DIS-identified patients with serious psychopathology, needing active assessment and intervention, who were unrecognized, undiagnosed or untreated. Implications of these findings for the psychiatric training of primary care physicians are examined.
TL;DR: One additional and noteworthy finding in the case of a patient who repeatedly injected himself intravenously with elementary mercury in suicide attempts was that documented deposits of elemental mercury in the right parietal lobe of the brain did not correlate with any specific deficits on neuropsychological testing.
Abstract: The case of a patient who repeatedly injected himself intravenously with elementary mercury in suicide attempts is presented and the toxicological effects of this chemical form and route of exposure of mercury are examined. A review of the literature reveals that elemental mercury, when injected as opposed to inhaled, causes few of the effects typical of mercurialism; pleuritic chest pain was frequently reported, whereas renal and central nervous system involvement were less common. Evidence of premorbid psychiatric disturbances was found in ten of fourteen non-cardiac catheterization exposures to intravenous elemental mercury. Findings in our patient were consistent with these observations. One additional and noteworthy finding in our case was that documented deposits of elemental mercury in the right parietal lobe of the brain did not correlate with any specific deficits on neuropsychological testing. Consultation-liaison psychiatry plays an important role in the treatment and care of these complex patients.
TL;DR: Alternatives such as MAO inhibitors, alprazolam, bupropion and psychostimulants are currently being explored in this patient population of elderly depressed patients.
Abstract: Depression and suicide are significant problems in the elderly, both in terms of their severity and their prevalence. It is particularly difficult to distinguish depression from early dementia, since elderly depressed patients often deny mood disorder and focus on their memory problems. This differential diagnostic dilemma is further complicated by the fact that 20 percent of Alzheimer-type dementia patients have moderate to severe depression. An even higher prevalence of depression can be seen in elderly patients with stroke or Parkinson's disease. Most all of the depressive disorders of the elderly are amenable to one form or combination of therapies: pharmacologic, electro-convulsive, or psychotherapy. Tricyclic antidepressants are often associated with adverse drug reactions in the elderly, so alternatives such as MAO inhibitors, alprazolam, bupropion and psychostimulants are currently being explored in this patient population.
TL;DR: Two patients with anhedonic ejaculation (ejaculation without orgasm) associated with initiation of treatment with desipramine are reported.
Abstract: Sexual dysfunction secondary to antidepressant drugs is an under-recognized clinical problem, and likely an important factor in noncompliance with treatment. We report two patients with anhedonic ejaculation (ejaculation without orgasm) associated with initiation of treatment with desipramine.
TL;DR: Both diagnostic and management aspects of the interictal psychopathology of epilepsy are discussed, including the relative seizure threshold lowering effects of psychotropic drugs and the behavioral effects of altering the seizure control.
Abstract: Epilepsy is associated with interictal behavioral disturbances. The pattern of specific psychopathology differs from that of other chronic diseases because of the higher incidence of psychosis and characterological disorders. Approximately 7 percent of epileptics develop a chronic atypical psychosis with paranoid and affective features, and this may be more common in patients with a definite temporal lobe focus. Brief psychotic episodes occur and are more directly related to cerebral dysrhythmia. A subgroup of epileptics develop specific personality traits, aggressive behaviors under certain circumstances, and hyposexuality. Affective illness and suicide are also prevalent. There are special issues in the management of psychopathology in the setting of epilepsy such as the relative seizure threshold lowering effects of psychotropic drugs and the behavioral effects of altering the seizure control. This article discusses both diagnostic and management aspects of the interictal psychopathology of epilepsy.
TL;DR: It was concluded that integration of psychiatric knowledge and skills into a primary care practice may be profoundly (and negatively) influenced by factors in the residents' training environment.
Abstract: The purposes of this study were to investigate the relationship between 1) residents' psychiatric performance and their primary care training environment; 2) residents' psychiatric performance and their year of training; and 3) the utility of feedback from the General Health Questionnaire (GHQ) and the year of training. Resident physicians (N = 32) were assigned to experimental and control groups; feedback of GHQ results constituted the intervention in the experimental site. Baseline data, as well as post intervention data, were collected on a total of 1040 patient encounters. Residents' psychiatric performance was measured by notation of a mental disorder in the Assessment portion of the SOAP note. Results showed that control group residents achieved superior performance at pretest and, in spite of a two-fold increase in the number of psychiatric diagnoses following GHQ feedback, experimental site posttest diagnoses did not significantly exceed control site frequency. In addition, experimental site first-year residents outperformed second-year residents, who likewise outperformed third-year residents, in recognizing their patient's mental distress. Differences in patient morbidity, over-diagnosis by first-year residents, and failure to have acquired psychiatric skills when a first-year resident were all tested and rejected as explanations for the unexpected inverse relationship between performance and years in training. It was therefore concluded that integration of psychiatric knowledge and skills into a primary care practice may be profoundly (and negatively) influenced by factors in the residents' training environment.
TL;DR: One hundred and one consecutively admitted orthopedic patients with leg fractures participated in a study assessing psychiatric morbidity using the BSI- and SMAST-questionnaires, with substance abuse being the leading group of disorders.
Abstract: One hundred and one consecutively admitted orthopedic patients with leg fractures participated in a study assessing psychiatric morbidity using the BSI- and SMAST-questionnaires. Patients identified as probable cases of psychopathology were then psychiatrically evaluated to establish diagnoses. It was determined that about 70 percent of the sample met the criteria for psychiatric diagnoses, with substance abuse being the leading group of disorders. The psychiatric consultation-liaison and orthopedic services remained blind to the research activities and continued to refer patients for psychiatric consultation when clinically necessary. Only six (5.9%) of the patients also participating in the study were referred for clinical consultation, and these appeared to have very obvious symptoms or complaints. The large majority of emotional distress remained unnoticed.
TL;DR: Despite the fact that between pre- and posttest boys with hemophilia and their parents became aware of the risk of contracting AIDS from blood product use, personality traits and parent child-rearing attitudes remained positive.
Abstract: Using standardized instruments, personality traits of twenty-two hemophilic boys and child-rearing attitudes and practices of their parents were evaluated at the beginning and end of a six-year period, during which psychosocial services were provided in a comprehensive care hemophilia program. The children changed significantly in a positive direction on two traits, enthusiasm and self-reliance. No significant negative personality trait changes were found. Scores remained within the normal range on the remaining traits, with the exception of a significant positive elevation on the intelligence dimension at both pre- and posttest. Mothers and fathers scored positively compared with parental attitude norms during both the initial and follow-up evaluations, without significant changes in overall mean scores. Strong relationships were revealed between individual changes in child personality and parent attitude scores. Despite the fact that between pre- and posttest boys with hemophilia and their parents became aware of the risk of contracting AIDS from blood product use, personality traits and parent child-rearing attitudes remained positive.
TL;DR: Using a combination of standardized and Likert-type measures of health, disability, and psychological adjustment, this study compared the quality of life reported by inpatients and outpatients approximately eight months after completing treatment.
Abstract: Using a combination of standardized and Likert-type measures of health, disability, and psychological adjustment, this study compared the quality of life reported by thirty-seven inpatients and thirty-six outpatients approximately eight months after completing treatment. While both patient groups reported treatment-related changes, inpatients were significantly more dysfunctional than outpatients both before and after treatment. The pattern of perceived improvement among inpatients reflected particular changes in narcotic use and in “up” time. For outpatients, the pattern of change pointed to increased periods of activity. The data are interpreted to reflect the need for treatments that are tailored to meet the differing levels of dysfunction of patients who present with chronic pain syndromes. Methodological problems of this and other clinical studies that compare treatment effects on patients demonstrating different levels of dysfunction are discussed.
TL;DR: During three and a half years of psychiatric liaison with a cardiac transplantation program, the authors evaluated and followed 101 transplantation candidates and ten exhibited pronounced ambivalence toward cardiac transplants.
Abstract: During three and a half years of psychiatric liaison with a cardiac transplantation program, the authors evaluated and followed 101 transplantation candidates. Ten exhibited pronounced ambivalence toward cardiac transplantation. Ambivalence appears to be associated with three factors: difficulties facing the seriousness of the cardiac illness, fear of the actual operation, and quality of life-concerns. An essentially nonpathological response, ambivalence can produce significant psychiatric symptoms and management problems in transplant candidates. Its resolution can be facilitated by psychotherapy, appropriate medication, peer support, and patience. Some patients may need particular assistance in understanding that refusal of transplantation is an acceptable alternative.
TL;DR: It was found that the LOC scores of women meeting criteria for PMS rose significantly (became more “external”) premenstrually, while scores of Women without PMS did not show significant change.
Abstract: Seventy-six women completed a three-month prospective evaluation for premenstrual syndrome (PMS). As a part of the evaluation, they completed Rotter's Locus of Control (LOC) form in the follicular phase and premenstrually. It was found that the LOC scores of women meeting criteria for PMS rose significantly (became more "external") premenstrually, while scores of women without PMS did not show significant change. In addition, the premenstrual LOC scores of women meeting criteria for PMS were significantly higher than were scores of the non-PMS women. The results are consistent with the idea that cycle related changes in self-perception occur in women demonstrating PMS symptomatology.
TL;DR: The results suggest that psychiatrists can predict which medically ill patients are at risk for complications and an important role for consultants is to identify those patients at high risk for significant complications.
Abstract: In this study we evaluated the side effects of antidepressant use in medically ill patients. The authors evaluated fifty-one general hospital inpatients who were later prescribed antidepressant medications by their primary care physicians. These patients' medical records were reviewed one year later for evidence of serious complications. The overall complication rate was 43 percent. When the psychiatrist recommended antidepressant therapy, there was a 30 percent incidence of major complications. When the psychiatrist did not recommend antidepressants, but the patient was treated anyway, the incidence of treatment-limiting side effects was 67 percent. These results suggest that psychiatrists can predict which medically ill patients are at risk for complications. Since most antidepressants are prescribed by non-psychiatrists, an important role for consultants is to identify those patients at high risk for significant complications.
TL;DR: The findings suggest that a variety of education and training approaches could be advantageously utilized to integrate and upgrade the care of patients by the different medical specialties.
Abstract: In a prior study a questionnaire was developed which reliably measured a variety of physicians' attitudes toward patients. In the present study we have used this questionnaire to compare the attitudes of physicians specializing in Internal Medicine, Surgery, Pediatrics and Psychiatry with one another and with a group of medical students. One way analyses of variance yielded highly significant differences (p less than .001) among these groups on the "Nurturant-Empathic" attitudinal dimension, as well as on the "Psychodynamic" and "Moral Weakness" Etiology Scales. Significance and ramifications of these findings are discussed in terms of the impact of these attitudes on treatment approach, clinical decision-making, and quality and comprehensiveness of patient care. Further, these findings suggest that a variety of education and training approaches could be advantageously utilized to integrate and upgrade the care of patients by the different medical specialties.
TL;DR: Comparison of the three groups with depressive illness revealed some differences that would suggest a less severe depressed mood in association with hypochondriacal symptoms.
Abstract: Of 100 inpatients with depressive illness, fifty-three had evidence of depressed mood prior to their hypochondriacal symptoms, sixteen had the opposite sequence of development and thirty-one had no hypochondriacal symptoms. Comparison of the three groups revealed some differences that would suggest a less severe depressed mood in association with hypochondriacal symptoms. Whether hypochondriasis preceded or followed depressed mood did not make any other difference to the total clinical picture. This should not be taken to imply that treatment and prognosis are the same in hypochondriacal and nonhypochondriacal depressions.
TL;DR: A case of hypopituitarism following childbirth (Sheehan's Syndrome) presenting with delirium is described and the patient remains symptom-free for the last three years on maintenance hormonal therapy.
Abstract: A case of hypopituitarism following childbirth (Sheehan's Syndrome) presenting with delirium is described. Diagnosis was confirmed with pituitary stimulation tests and the patient remains symptom-free for the last three years on maintenance hormonal therapy.
TL;DR: Diagnostic features of drug-induced akathisia are focused on as well as possible treatment approaches, which demonstrate the close anatomic and functional relationship between cortical and subcortical dopaminergic pathways.
Abstract: Drug-induced akathisia is a significant and common iatrogenic disorder. It involves both a subjective component of a disturbing sense of compulsion to move and an objective component of motor restlessness. Akathisia is being seen with increasing frequency in medical and surgical patients. This is due to the increased use of anti-emetics or novel adjuncts to pain control as well as more widespread use of the major psychoactive drugs throughout medicine. This review focuses on diagnostic features of the disorder as well as on possible treatment approaches. In addition, the disorder demonstrates the close anatomic and functional relationship between cortical and subcortical dopaminergic pathways. Akathisia is thus both an increasingly significant clinical problem and a fascinating glimpse at the relationship between brain function and behavior.