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Biomedical subjects

A Stoudemire

Publications and source records attributed to A Stoudemire.

At least 19 recordsLinked to original sources
PubMed1997

Recurrence and relapse in geriatric depression: a review of risk factors and prophylactic treatment strategies.

An emerging body of epidemiologic data has substantiated that in younger and middle-aged populations, major depression may be characterized by early relapse, recurrence, and chronicity. Information regarding the prognosis of geriatric depression is less extensive. This article reviews the literature on the longitudinal outcome of major depression in older adults, with particular emphasis on the limited data on strategies for the pharmacologic and electroconvulsive prophylaxis of recurrent unipolar geriatric depression. Possible biological markers for relapse risk, derived from sleep electroencephalography, neuroendocrine tests, and neuroradiographic findings, are also discussed. Recommendations for the treatment and long-term follow-up of geriatric depression are presented.

Aged↗
PubMed1996

Major depression in the primary care setting.

This article has provided a brief overview of the prevalence, differential diagnosis, and clinical manifestations of depression in the primary care setting. While the high prevalence of depression is well documented, another body of evidence is accruing that demonstrates that depression not only increases over utilization of medical resources, but may worsen the long-term prognosis of certain medical conditions such as MI. Evidence also suggests that the diagnostic and management skills of primary care physicians--who comprise the "front line" and may offer the only line of care for these patients--is in need of improvement. This series of articles focusing on the diagnosis and treatment of depression in primary care will hopefully contribute to that effort.

Comorbidity↗
PubMed1996

OBRA regulations and the use of psychotropic drugs in long-term care facilities: impact and implications for geropsychiatric care.

This article reviews governmental guidelines regulating the use of psychotropic drugs in long-term care facilities as established by the Omnibus Budget Reconciliation Act (OBRA) of 1987 and their impact on the use of psychotropic agents in these settings. A major component of these guidelines is to regulate the clinical indications for psychoactive drugs (neuroleptics, benzodiazepines, and sedative hypnotics) in residents of long-term care facilities. Responsibilities of the prescribing physician, facility medical director, and consulting pharmacist--as well as quality assurance procedures-in complying with OBRA regulations are examined. Evidence that OBRA regulations have reduced the use of psychotropic drugs and physical restraints in long-term nursing facilities is reviewed. Implications of the OBRA regulations for the training and clinical practice of psychiatrists and primary care clinicians are discussed as well as recommendations for increasing the availability of mental health services for this patient population via multidisciplinary geropsychiatric consultation-liaison teams.

Aged↗
PubMed1996

Corticosteroid-induced delirium and dependency.

A case of a patient with chronic lung disease who developed an addiction pattern of corticosteroid dependency is described in which steroid-induced delirium also developed. The rare phenomenon of corticosteroid dependency is discussed as well as the phenomenology and possible mechanisms of steroid-induced delirium.

Adult↗
PubMed1996

New antidepressant drugs and the treatment of depression in the medically ill patient.

The advent of the SSRIs, venlafaxine, bupropion, and nefazodone, has greatly expanded pharmacologic treatment options for the depressed medically ill patient. Although the relatively benign side effects of these medications on cardiac conduction and blood pressure allow for more liberal use in the medically ill, these drugs nevertheless have different capacities for adverse drug interactions that must be considered. Nevertheless, such interactions can usually be avoided or managed by knowledgeable clinicians cognizant of the pharmacodynamic and pharmacokinetic principles outlined in this article.

Adjustment Disorders↗
PubMed1996

Epidemiology and psychopharmacology of anxiety in medical patients.

A wide variety of comorbid anxiety disorders have been described in patients with medical disorders, with the most common being adjustment disorder with anxiety, panic disorder, and generalized anxiety disorder. This article briefly reviews representative studies of the prevalence of anxiety disorders in several medical conditions, placing emphasis on cardiovascular, pulmonary, cerebrovascular, and dermatologic disease. Psychotropic medications appropriate for the treatment of anxiety disorders in these medical-psychiatric populations (benzodiazepines, cyclic antidepressants, and buspirone) as well as beta-adrenergic blocking agents and antihistamines are discussed with an emphasis on pharmacokinetic and drug interactions of major clinical importance for the medically ill patient.

Adrenergic beta-Antagonists↗
PubMed1995

The role of ciprofloxacin in a patient with delirium due to multiple etiologies.

A 40-year-old female with a lumbar drain was admitted to the neurosurgery service with a bacterial meningitis. During the course of her treatment with multiple central nervous system (CNS) active medications, the patient became disoriented and agitated with visual hallucinations and generalized myoclonus. A psychiatric consultation was requested. The case is presented and discussed within the context of the importance of understanding etiological mechanisms in treating and reversing delirium. The fluoroquinolone agent ciprofloxacin was considered to be the primary etiology of the patient's delirium. This class of medication as a cause of altered mental status is discussed.

Adult↗
PubMed1995

The future of consultation-liaison psychiatry and medical-psychiatric units in the era of managed care.

There has been increasing recognition and documentation of the impact of psychiatric problems on the outcome and cost of medical care. Because consultation-liaison psychiatrists have the expertise to address the psychiatric aspects of medical illness, this group should be in a strong position to facilitate integration of medical and psychiatric services in managed care delivery systems. Although consultation-liaison psychiatry (CLP) has documented its ability to shorten inpatient medical lengths of stay for some disorders, a greater challenge exists in developing comprehensive systems to identify and care for patients with mental health problems in primary care settings. This paper reviews the fiscal and programmatic implications for managed medical care systems of findings from outcome-based C-L research. The future role of CLP and combined medical-psychiatric units in an era of managed care is also discussed.

Cost-Benefit Analysis↗
PubMed1995

Improvement in depression-related cognitive dysfunction following ECT.

Long-term cognitive changes were observed in 8 depressed patients whose pretreatment cognitive impairment (depressive dementia or pseudodementia) resolved after treatment with ECT. Improved performance on the Mattis Dementia Rating Scale was maintained throughout a 4-year follow-up period. Improvements on Memory and Initiation and Perseveration subscales were most consistent over time. These aspects of cognitive functioning may be the most susceptible to the effects of depression, and this may be a factor to consider in clinically evaluating older patients with both depression and cognitive impairment. The findings indicate that elderly patients with cognitive dysfunction secondary to depression may experience improvement in cognitive functioning that is stable over time with remission of the affective disorder.

Aged↗
PubMed1994

Rehospitalization rates in older depressed adults after antidepressant and electroconvulsive therapy treatment.

OBJECTIVE: To determine (1) if a "high risk" period for rehospitalization can be identified in a population of depressed older adults and (2) if age of onset and previous history of depression is associated with an increased risk of rehospitalization. DESIGN: Naturalistic, longitudinal treatment outcome study. SETTING: Medical-psychiatry unit and outpatient clinic at a university hospital. PATIENTS: Ninety-four older adults diagnosed with major depression based on SCID and DSM-III-R criteria who were hospitalized for treatment. INTERVENTIONS: All patients were initially hospitalized on a medical-psychiatry unit and treated with either antidepressants or electroconvulsive therapy. MEASUREMENTS: Patients were initially evaluated with the Structured Clinical Interview for DSM-III-R (SCID), the Hamilton Depression Rating Scale, and a battery of neuro-psychological and behavioral tests. Patients were followed over time with an average follow-up interval of 3.09 + 1.45 years, and the date of the first psychiatric rehospitalization (if any) was recorded. RESULTS: Approximately 43.6 percent of the total sample required at least one psychiatric rehospitalization. The greatest risk of rehospitalization occurred in the first 18 months. No significant differences were noted between patient groups treated with ECT and those treated with antidepressants or between patients with a younger and those with an older age of onset of depressive disorder. A statistical trend was observed in which patients without previous episodes of depression had a lower overall rate of rehospitalization compared with patients with one or more previous episodes of depression. CONCLUSIONS: There appears to be a relatively high risk of psychiatric rehospitalization in depressed older adults, particularly in the first 18 months. This rate of rehospitalization underscores the importance of providing maintenance therapy and intensive psychiatric supervision for a minimum of 18 months to 2 years during the course of a depressive episode requiring inpatient hospitalization.

Age Factors↗
PubMed1993

Long-term outcome of treatment-resistant depression in older adults.

Seventeen elderly patients with treatment-resistant depression were reassessed 15 months and 4 years after treatment with an antidepressant agent or ECT. At 15 months 47% (seven of 15) were clinically improved, and at the 4-year follow-up 71% (10 of 14) were improved. These results indicate that treatment-resistant depression may improve over time because of either the natural course of the illness or persistent treatment efforts.

Age Factors↗
PubMed1993

Long-term affective and cognitive outcome in depressed older adults.

OBJECTIVE: The purpose of this naturalistic study was to examine the long-term (15 months and 4 years) cognitive and affective outcome following treatment with either cyclic antidepressants or ECT in depressed older adults. METHOD: Fifty-five patients meeting criteria for major depression were rated as to cognitive impairment and were treated as clinically indicated with either a cyclic antidepressant or ECT. Long-term outcome was determined through psychometric retesting 15 months (N = 47) and approximately 4 years (N = 44) after treatment. RESULTS: Analysis of 15-month and 4-year outcome evaluations revealed that the majority of patients improved over time with respect to their depression, regardless of whether they exhibited pretreatment cognitive impairment or were treated with cyclic antidepressants or ECT. Fifteen months and 4 years after treatment, 72.3% and 83.7% of patients, respectively, exhibited clinically meaningful improvement. However, patients given both cyclic antidepressants and ECT demonstrated a relatively high rate of rehospitalization (50%) over the course of the 4 years. Except for patients who developed dementia, cognitive functioning remained stable or improved for the majority of patients. In patients who received ECT, those with normal pretreatment cognition had stable cognitive functioning over time and those who had pretreatment cognitive dysfunction showed improvement over the 4-year follow-up period. CONCLUSIONS: Results of this study indicate that the long-term prognosis of depression in older adults is generally favorable, although they may be prone to relapse and recurrence, which points to the need for rigorous monitoring and follow-up care.

Age Factors↗
PubMed1993

Similarities and differences in memory deficits in patients with primary dementia and depression-related cognitive dysfunction.

The authors examined differences between the verbal memory performance of older patients with major depression (MD) alone; major depression with reversible depression-related cognitive dysfunction (MD/DRCD); and primary dementia and major depression (DEM/MD). Patients were evaluated before antidepressant treatment and 6 and 15 months after treatment. Of the three groups, patients with MD alone acquired significantly more information on the California Verbal Learning Test and showed a more pronounced primacy effect. Patients with DEM/MD were more likely to commit errors of intrusion. Although older depressed patients with MD/DRCD may resemble patients with DEM/MD on some aspects of verbal memory performance, differences may be observed in the types of learning errors they commit. Diagnostic implications are discussed.

Adult↗
PubMed1993

Psychopharmacologic treatment of anxiety in the medically ill elderly patient: special considerations.

The use of psychotropic agents to treat anxiety in medically ill elderly patients requires consideration of special pharmacokinetic and pharmacodynamic factors in drug selection. In this review, the use of seven general classes of psychotropic drugs with anxiolytic activity will be considered for use in the medically ill: benzodiazepines, azapirones, cyclic (non-monoamine oxidase [MAO] inhibitor) antidepressants, beta-adrenergic blocking agents, antihistamines, neuroleptics, and MAO inhibitors. Attention will be given to developing rational strategies for drug selection in order to minimize deleterious side effects, to which medically ill elderly patients may be vulnerable.

Age Factors↗
PubMed1992

Electroconvulsive therapy and the chronic use of pseudocholinesterase-inhibitor (echothiophate iodide) eye drops for glaucoma. A case report.

A case is presented in which a patient who required treatment with electroconvulsive therapy had a history of being treated with pseudocholinesterase-inhibitor eye drops (echothiophate iodide) for glaucoma. As treatment with this antiglaucoma agent contraindicated the use of succinylcholine for a minimum of 10-14 days, the short-acting nondepolarizing agent atracurium was employed instead. The anesthetic management of this patient is described as a guide for clinicians facing similar clinical situations.

Aged↗
PubMed1992

Pathophysiology and management of phantom limb pain.

Phantom pain phenomenon is a poorly understood but relatively common sequela of limb amputation that may result in significant psychological and physical morbidity. In this review, proposed pathoneurophysiological mechanisms for the development of phantom pain are reviewed as well as psychological mechanisms that may be involved. The authors recommend an integrated approach to management of chronic phantom pain that takes into consideration the multiple factors that may contribute to its etiology.

Adult↗