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Showing papers in "International Journal of Psychiatry in Medicine in 1995"


Journal ArticleDOI
TL;DR: Catatonia is a nonspecific syndrome with multiple etiologies and treatment of catatonia should be based on the underlying cause when it is identifiable, and lorazepam appears to offer a safe, effective first-line treatment ofcatatonia.
Abstract: Objective:The authors reviewed the recent literature regarding the treatment of catatonia as a syndrome of multiple etiologies. Given the historical and clinical association of catatonia with schizophrenia, the authors' examined the assumption that the first-line treatment of catatonia is antipsychotic medication.Methods:Articles published between January 1, 1985 and December 31, 1994 were located using the Paperchase® medical literature search system. Additionally, references from those identified articles were examined for possible inclusion in this review. To be included in this review, articles had to be written in English and report specific symptoms of catatonia to determine, retrospectively, if DSM-IV criteria for catatonia were met.Results:Seventy publications met inclusion criteria and reported on a total of 178 patients and included 270 separate treatment episodes. Most of the articles were case-reports, although a few case-series were identified. Multiple causes of catatonia were identified in ...

156 citations


Journal ArticleDOI
TL;DR: Boxing results in a spectrum of CTE ranging from mild, nonprogressive motor changes to dementia pugilistica, and Screening with neuropsychological tests and neuroimaging may help predict those boxers at risk for CTE.
Abstract: Objective:To review the neuropsychiatry of boxing.Method:This update considers the clinical, neuropsychological, diagnostic, neurobiological, and management aspects of boxing-related brain injury.Results:Professional boxers with multiple bouts and repeated head blows are prone to chronic traumatic encephalopathy (CTE). Repeated head blows produce rotational acceleration of the brain, diffuse axonal injury, and other neuropathological features. CTE includes motor changes such as tremor, dysarthria, and parkinsonism; cognitive changes such as mental slowing and memory deficits; and psychiatric changes such as explosive behavior, morbid jealousy, pathological intoxication, and paranoia. Screening with neuropsychological tests and neuroimaging may help predict those boxers at risk for CTE.Conclusions:Boxing results in a spectrum of CTE ranging from mild, nonprogressive motor changes to dementia pugilistica. Recent emphasis on safety in the ring, rehabilitation techniques, and other interventions do not elimin...

136 citations


Journal ArticleDOI
TL;DR: Male sexual side effects can occur randomly and involve any sexual phase randomly, and the treatment approaches are similar, regardless of the types of sexual dysfunction associated with antidepressants.
Abstract: Objective:This is a retrospective study to add to the existing body of clinical information regarding male sexual side effects associated with antidepressants. From the chart review, thirty-four ou...

99 citations


Journal ArticleDOI
TL;DR: It is suggested that SSRI-associated female sexual dysfunction occurs at a higher rate than previously thought, equal potentials in implicating female sexual side effects among three SSRIs, and the absence or the low incidence of female sexual adverse effects from bupropion.
Abstract: Objective:After the advent of selective serotonin reuptake inhibitors on the U.S. market in 1988, American psychiatrists have been faced with more choices of antidepressants for the treatment of depression. The prescribing of SSRIs has been increasing in popularity because they are easily titrated by the physicians and tolerated by patients. However, the SSRI use is frequently associated with female sexual dysfunction. The aim of this study was to describe these SSRI-associated female sexual side effects.Methods:In a retrospective series, clinic records of 110 female SSRI-treated outpatients were reviewed for loss of or decreased libido, orgasmic disturbances (anorgasmia or delayed orgasm), as well as clinical management patterns to alleviate sexual side effects.Results:Twenty-one fluoxetine-, nine paroxetine-, and five sertraline-treated cases with female sexual inhibition were identified. The fates of SSRI-associated sexual adverse effects and clinical managements of restoring these side effects were de...

79 citations


Journal ArticleDOI
TL;DR: Methylphenidate relieves depressive symptomatology with efficacy similar to that of desipramine, offering an alternative to patients who are unable to tolerate standard tricyclic antidepressant therapy.
Abstract: This report is a randomized, double-blind, comparative trial of desipramine with the psychomotor stimulant methylphenidate. Twenty HIV antibody-positive patients with depressive symptoms were randomly assigned to either drug. After individual dose titration, the mean daily dose of desipramine was 150 mg. and methylphenidate 30 mg. daily. The differences in responses between desipramine and methylphenidate were not statistically significant on various measures of depression. The antidepressant effect of methylphenidate did not occur any faster than that of desipramine. Both significantly reduced depressive and anxious symptomatology over the blinded portion of the treatments. Thus, methylphenidate relieves depressive symptomatology with efficacy similar to that of desipramine, offering an alternative to patients who are unable to tolerate standard tricyclic antidepressant therapy. The dopaminergic effects of methylphenidate are likely to mediate its antidepressant effects.

74 citations


Journal ArticleDOI
TL;DR: The author suggests that with these systematic approaches, this rapidly adding knowledge can help psychiatrists better understand psychotropic drug interactions and maximize the benefits of patients' psychopharmacotherapy.
Abstract: Objective:This article is a five-year update on a previous review article (International Journal of Psychiatry in Medicine, 21:47–56, 1991) on cytochrome P450 monooxygenases and interactions of psychotropic drugs.Method:In the literature review, the recent committee work on nomenclature of the P450 superfamily are highlighted. Then, the author reviewed gene clusters of three human cytochrome P450s—CYP1A2, CYP2D6, and CYP3A4 with the focus on the changes of serum levels of the coadministered psychotropic drugs in the context of enzymatic induction and inhibition of these three hepatic enzymes.Results:As indicated in one table, the author stratified probes, inducers, inhibitors, chemical reactions, and substrates under these three gene clusters. As shown in another simple table, the author compared the hepatic enzymatic inhibitions of four selective serotonin reuptake inhibitors and pointed out the inhibition potentials of fluvoxamine at CYP1A2, fluoxetine and paroxetine at CYP2D6, and fluoxetine and fluvox...

46 citations


Journal ArticleDOI
TL;DR: A comprehensive review of medical disorders in the schizophrenic patient is provided to provide the clinician interested in Consultation/ Liaison psychiatry and psychosomatic issues a comprehensive and current review of the subject.
Abstract: Objective:The primary purpose of this review of medical disorders in the schizophrenic patient is to provide the clinician interested in Consultation/ Liaison psychiatry and psychosomatic issues a comprehensive and current review of the subject.Method:The authors used the Index Medicus and Medline to find recent review articles and research articles related to medical disorders in the schizophrenic patient. Also, the authors described their clinical experience in Consultation/Liaison psychiatry working with schizophrenic patients in a large, tertiary-care academic medical center.Results:The authors divided their review into: 1) mortality and morbidity in schizophrenia, 2) differential diagnosis, 3) specific comorbidity management problems, 4) caring for schizophrenics on medical/surgical wards, and 5) antipsychotic drugs in the medical setting. Schizophrenia remains an important subject for Consultation/Liaison psychiatrists.Conclusions:Schizophrenia and its protean manifestations confound the care of the...

46 citations


Journal ArticleDOI
TL;DR: A single case is used to identify and illustrate distinct ways in which patients exert power to determine the outcome of consultations, leading to a more powerful explanation than is presently available to understand the somatization of psychological needs.
Abstract: Objective: Extensive empirical data and theory describe the inequality of power in relations between doctors and their patients. However, the focus has been on the ways in which doctors control the doctor-patient relationship. This has meant that the extent to which patients influence the consultation, and the ways in which they do this, have been neglected. Methods: In this article, we use a single case to identify and illustrate distinct ways in which patients exert power to determine the outcome of consultations. Conclusion: This analysis leads to a more powerful explanation than is presently available to understand the somatization of psychological needs. According to this, the patient organizes strategies, which include the presentation of emotional and social distress, around a biomedical model. Because of their prior decisions as to their role, doctors permit themselves to be trapped in this model.

39 citations


Journal ArticleDOI
TL;DR: The two formats of a brief, group psychoeducational program for cancer patients; a standard format of six weekly two-hour sessions or a “weekend intensive,” involving the same content and contact time compressed into two days were found to be equivalent in their overall effects on mood and quality of life.
Abstract: There is considerable evidence that brief group psychoeducational programs for cancer patients, offering support and some training in coping skills, may have lasting beneficial effects on mood and

39 citations


Journal ArticleDOI
TL;DR: In general, these drugs appear to be a reasonable treatment choice for certain types of mood, behavior, and cognitive symptoms following brain injury, but it is noted that larger scale controlled studies are needed to adequately assess the clinical usefulness of these drugs.
Abstract: Objective:The primary purpose of this article is to review certain neuropsychiatric sequelae of stroke and traumatic brain injury (TBI), and the role of the psychostimulants methylphenidate (MPD) and dextroamphetamine (DAMP) in their treatment.Method:A general review of the topic is presented. Controlled and uncontrolled studies involving the use of the psychostimulants are discussed. These consist of 11 studies listed with Medline 2000 that deal specifically with stroke or head injury, with the oldest study reviewed dating back to 1984. Studies concerning the use of psychostimulants in the medically or neurologically ill are reviewed to the extent that they are pertinent.Results:The current literature consists primarily of uncontrolled case studies. However, these are reviewed and found to suggest a role for the use of the psychostimulants, which is discussed.Conclusions:In general, these drugs appear to be a reasonable treatment choice for certain types of mood, behavior, and cognitive symptoms followin...

36 citations


Journal ArticleDOI
TL;DR: It is concluded that personality neuroticism may be a risk factor for depression following stroke and correlated positively with depressive symptomatology.
Abstract: Aim:The aim of this study was to determine whether personality neuroticism or extroversion traits are associated with post-stroke depression.Method:Ninety-four stroke inpatients undergoing rehabilitation were examined two months post-stroke for the presence and severity of depression and a retrospective assessment was made of life-time neuroticism and extroversion.Results:Depressed patients (N = 35) had higher neuroticism scores than non-depressed patients. Neuroticism was correlated positively with depressive symptomatology. Extroversion was not associated with depression diagnosis or depressive symptomatology.Conclusion:We conclude that personality neuroticism may be a risk factor for depression following stroke.

Journal ArticleDOI
TL;DR: Clinical experience with MPD treatment of cognitive changes in men with HIV/AIDS is consistent with the notion that this medication holds significant promise to improve the quality of life for persons living with HIV /AIDS.
Abstract: Objective:Complaints of cognitive changes are often expressed by patients at all stages of HIV infection. Such changes include decreased memory and attention span, diminished concentration, apathy, and “slowing.” Methylphenidate (MPD) has been used in several clinical studies in men with late-stage HIV disease in an attempt to ameliorate these difficulties. The objectives of this review article are to review salient psychopharmacological characteristics of MPD and to describe the research and clinical literature supporting the use of MPD in patients at all stages of HIV infection.Methods:Seven studies, case reports, or abstracts from International Conferences on AIDS were available in the English literature through August, 1993, directly addressing the use of MPD in patients with HIV disease. Twenty-nine papers were reviewed for pharmacokinetic data, eighteen for safety and side effects issues, and seventeen for relevant contributions from the neuropsychological testing literature.Results:Studies in clini...

Journal ArticleDOI
TL;DR: Careful differential diagnosis is an essential preliminary step to successful treatment and consideration of both the benefits and the risks of medication management is recommended, as elderly patients are especially vulnerable to side effects.
Abstract: Objective:The authors review the evaluation and treatment of anxiety symptoms in elderly patients, with particular emphasis on elderly patients with chronic medical illness.Methods:A computer searc...

Journal ArticleDOI
TL;DR: This overview addresses the basic chemistry, pharmacology, activity, medical uses, drug interactions and adverse side effects of the psychostimulants.
Abstract: This overview addresses the basic chemistry, pharmacology, activity, medical uses, drug interactions and adverse side effects of the psychostimulants.

Journal ArticleDOI
TL;DR: Hospital-reported stressors may contribute to the emotional distress that elderly inpatients experience and an index to identify such stressors is developed.
Abstract: Objective:To develop a long and short version of an index to measure experiences during hospitalization perceived by elderly patients as stressful.Samples and Methods:Consecutive patients aged sixty or over admitted to a university teaching hospital were assessed for hospital-related stressors during two separate studies. In the first study, seventy-six patients were asked an open-ended question exploring what they found most stressful about being in the hospital. Responses were grouped into major categories, and questions were developed to address concerns in each category; the resulting forty items were called the Hospital Stress Index (HSI). The HSI was then administered to a separate group of ninety-two patients; data were also collected on functional disability (impaired ADLs), dysfunctional attitudes (DAS), and depressive symptoms (CES-D).Results:Spontaneously reported hospital stressors were grouped into seven categories: 1) adverse effects of diagnostic or therapeutic procedures/treatments, 2) for...

Journal ArticleDOI
TL;DR: The results suggest that although the Mini Mental State Exam is widely used to assess cognitive mental status, it may have limited value in identifying patients with cognitive impairment post-cardiac surgery, and special attention must be paid to the cut-off scores used in interpreting the MMSE.
Abstract: Objective:The present longitudinal study was designed to: 1) determine the ability of the Mini Mental State Exam (MMSE) to predict neuropsychologic impairment based on neuropsychologic testing five to seven days and six weeks after cardiac surgery; and 2) to determine whether the traditional or the education-related MMSE norms are more appropriate to use for this purpose.Method:The day before surgery (T1), before hospital discharge (T2), and six weeks after surgery (T3), 247 subjects completed a battery of five neuropsychologic tests. Subjects also completed the Center for Epidemiological Studies Depression Scale and the Speilberger State-Trait Anxiety Inventory. Subjects completed the MMSE two to three days after surgery.Results:Stepwise regression analyses revealed that the MMSE significantly predicted only a small portion of the variance in neuropsychologic test performance at T2, and to an even lesser extent at T3, over and above the demographic variables. In assessing the association between an impai...

Journal ArticleDOI
TL;DR: The research looks at people's appraisals and responses to the specific stressor of living with chronic low back pain, and identifies the desirability, if not need, for a somatic focus, the reliance on higher order cognitive strategies for planful action, and the use of a varied repertoire of coping strategies.
Abstract: Objective:This article explores the coping construct held by individuals with chronic low back pain. The research addresses two criteria identified as important for coping research: it looks at people's appraisals and responses to the specific stressor of living with chronic low back pain, and it seeks to identify what these individuals actually think and do in response to the ongoing stressor of living with chronic pain.Method:Fifteen people with chronic low back pain who responded to a media release participated in focus group discussions on coping with chronic pain.Results:Analysis indicated the desirability, if not need, for a somatic focus, the reliance on higher order cognitive strategies for planful action, and the use of a varied repertoire of coping strategies.Conclusions:These findings are discussed both in terms of adjustment to chronic illness and in relation to current pain management practices.

Journal ArticleDOI
TL;DR: The postpartum illness dramatically changed some women's reproductive plans and prevention strategies for these illnesses need to be addressed when women are making decisions about having other children.
Abstract: Objective:We investigated the relationship between postpartum psychiatric episodes and subsequent family planning. Our hypothesis was that women who had a postpartum illness would plan to have fewer children.Method:We conducted a mail survey of members of the self-help group Depression After Delivery (DAD). The membership was asked about changes in family planning after a postpartum illness. Two groups were defined: women who took action to prevent further pregnancies after the illness (CHANGE) and women who did not take action to prevent future pregnancies (NO CHANGE).Results:Among respondents 32 percent changed their family plans after suffering a postpartum illness. Fear of recurrence, effects on the family, treatment costs and severity of the episode manifested by suicide or infanticide attempt, hospitalization, and prescribed medication were reasons given for altering plans.Conclusions:The postpartum illness dramatically changed some women's reproductive plans. Prevention strategies for these illness...

Journal ArticleDOI
TL;DR: The FSQ appears to be appropriate for use with geriatric ambulatory medical patients, and highlighted the positive influence of intermediate activities of daily life—involving moderate levels of physical activity—on satisfaction with health, and the negative effect of depression on physical activity.
Abstract: Objective : The Beth Israel/UCLA Functional Status Questionnaire (FSQ) is a multidimensional self-report instrument used for assessing the physical, social, and psychological status of children and adults. This study assessed the appropriateness of the FSQ for use with geriatric (at least 65 years of age) ambulatory medical patients. Method : Concurrent cohort convenience samples of forty geriatric and eighty-five nongeriatric ambulatory patients were drawn from a general internal medicine clinic. Patients completed the FSQ while waiting to see their physician. Analyses were conducted in order to : 1) address the magnitude and pattern of missing responses that are generated when the FSQ is administered to small groups ; 2) assess whether, as was intended, each of the different FSQ subscales is unidimensional ; 3) evaluate the magnitude and pattern of variances and covariances of items constituting FSQ subscales ; 4) compare profiles of FSQ scores between geriatric versus nongeriatric samples ; and 5) investigate whether FSQ subscales correlate with different self-report outcome measures in a convergent or divergent manner. Results : For both samples, FSQ subscales were internally consistent and moderately variable. Cross-sectional comparisons revealed both convergent and divergent relationships between FSQ subscales and measures of social support and satisfaction with health. Conclusions: the FSQ appears to be appropriate for use with geriatric ambulatory medical patients. Findings highlighted the positive influence of intermediate activities of daily life-involving moderate levels of physical activity-on satisfaction with health, and the negative effect of depression on physical activity.

Journal ArticleDOI
TL;DR: Cognitive and psychiatric features of multiple sclerosis can manifest as a neuropsychiatric disturbance even in the absence of physical disabilities, resulting in specific cognitive deficits and mood disorders.
Abstract: Objective:This article examines the cognitive and psychiatric features of multiple sclerosis. MS can manifest as a neuropsychiatric disturbance even in the absence of physical disabilities.Method:Two MS patients with predominant behavioral symptoms are described, and the literature is reviewed.Results:The first patient had an interhemispheric disconnection syndrome, and the second patient had cognitive fatigue and depression. Other patients have slowed information processing speed, memory retrieval difficulty, frontal-executive dysfunction, and visuospatial difficulty.Conclusions:MS results in specific cognitive deficits and mood disorders. These two patients had organic mental disorders from cerebral demyelination particularly affecting the corpus callosum. Other patients have neuropsychiatric symptoms from extensive demyelination of prefrontal-subcortical circuits. Evaluation and management strategies are discussed.

Journal ArticleDOI
TL;DR: Recognition and management of the countertransference reactions likely to emerge in therapy with factitious disorder patients are particularly important if the therapy is to be maximally effective.
Abstract: Objective:Patients who simulate or actually self-induce illnesses to assume the “sick role” present a number of imposing psychotherapeutic challenges. The purpose of this article is to discuss the countertransferential reactions that are mobilized in therapy with these patients.Method:Literature searches of the MEDLINE and HEALTH databases were performed using the term “factitious disorder.” The resulting citations were examined for descriptions of the potential and actual countertransference responses in therapy with such patients. The few citations with relevant material were supplemented with other clinical literature on countertransference as well as observations from cases in which the authors have served as therapists or consultants.Results:Once the medical dissimulation has been exposed, the most conspicuous difficulty is in persuading the patient to agree to therapy. When therapy does take place, both the patient's overt behaviors, such as actual bodily damage, and his or her underlying emotional ...

Journal ArticleDOI
TL;DR: Although clozapine therapy should be reserved for those patients who are refractory to conventional psychotropic medications, when used appropriately it may offer a safe and effective way of improving quality of life for patients with behavioral symptoms and neurologic illness.
Abstract: Objective:This review will analyze the use of clozapine in patients with neurologic illness.Methods:A review of the literature was performed. Attention is focused particularly on patients with seizure disorder, head injury, mental retardation, Parkinson's disease, Huntington's disease, tardive dyskinesia, and selected other neurological disorders.Results:This review discusses clinical difficulties/issues associated with clozapine therapy in patients with a variety of neurological disorders.Conclusion:Although clozapine therapy should be reserved for those patients who are refractory to conventional psychotropic medications, when used appropriately it may offer a safe and effective way of improving quality of life for patients with behavioral symptoms and neurologic illness.

Journal ArticleDOI
TL;DR: Improvement of neurologic training to include appropriate interview techniques is suggested, providing the integration of biological, psychological and social factors in diagnosis and therapy.
Abstract: Objective:This pilot study investigated the prevalence of psychological distress and cognitive impairment in neurological in-patients by means of three widely accepted questionnaires. We examined residents' recognition of corresponding disturbances.Method:We interviewed fifty-five consecutively admitted in-patients of a neurological unit with the MMSE, GHQ-28 and BDI. We asked the neurological residents whether they found cognitive impairment or psychological disturbances in their patients and to indicate the extent of those abnormalities.Results:Fifteen percent of patients showed cognitive impairment, but as many as one-third showed psychological problems warranting further work-up. Recognition of such by residents as well as specification of psychiatric diagnoses and important psychosocial factors in the final reports was poor.Conclusion:Psychological problems are common in neurologic in-patients. They are insufficiently recognized by residents and usually not taken into consideration in patient-care. W...

Journal ArticleDOI
TL;DR: The development and validation of the Diabetes Emotional Adjustment Scale in Spanish is presented and there were significant correlations between the scale results and measures of depression, trait-anxiety, family adjustment, and locus of control of behavior.
Abstract: Objective:The development of instruments to measure emotional maladjustment in diabetic Hispanic populations has received little attention. We present the development and validation of the Diabetes Emotional Adjustment Scale in Spanish.Method:An eighteen-item self-administered scale was construed to assess emotional adjustment in Spanish-speaking diabetic patients and the psychometric properties of the scale were assessed. The scale was applied to a sample of sixty patients and scale scores were correlated with scores on a battery of Spanish versions of established measures of psychological distress, to assess concurrent validity. Test-retest reliability was established four years later re-examining thirty-eight of the initial sixty-patients sample.Results:Split-half reliability and test-retest reliability were satisfactory. There were significant correlations between the scale results and measures of depression, trait-anxiety, family adjustment, and locus of control of behavior. A principal component ana...

Journal ArticleDOI
TL;DR: Concerns about the toxicities of psychomotor stimulants originate primarily from effects seen at high doses, when stimulants are abused, and are generally associated with only minimal, short lived side effects, which are detailed herein.
Abstract: Concerns about the toxicities of psychomotor stimulants originate primarily from effects seen at high doses, when stimulants are abused. Low dose use in the apathetic medically ill patient has been generally associated with only minimal, short lived side effects, which are detailed herein. Confusion may be worsened in already delirious patients. Anxiety, psychosis, cardiovascular effects, insomnia, and tremor may occur but infrequently require discontinuation. Appetite is normally stimulated in the medically ill. In fact, stimulants are frequently utilized in the medically ill largely because of their minimal toxicity. The history of U.S. stimulant abuse in the twentieth century is briefly discussed. Abuse of prescribed stimulants appears to be infrequent. Over-zealous concern regarding abuse has previously led to unfortunate declines in appropriate utilization of stimulants, e.g., for attention deficit disorder. Guidelines for prescribing stimulants in light of abuse potential are included.