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Biomedical subjects

B S Fogel

Publications and source records attributed to B S Fogel.

At least 19 recordsLinked to original sources
PubMed1991

Psychotropic drug use in the medically ill. Part II.

Underlying medical illness and drug interactions may make the use of psychotropic agents problematic in some physically ill patients. This overview, published in two parts, discusses six major classes of psychotropic medications (cyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines, neuroleptics, lithium, psychostimulants, and carbamazepine) and examines their use in the setting of specific types of medical illnesses (e.g., cardiovascular, pulmonary, hepatic, and renal disease). Practical considerations in using psychotropic medications in medical-surgical patients--particularly those who are elderly or medically debilitated--will receive special emphasis.

Drug Interactions↗
PubMed1991

The high sensitivity cognitive screen.

Ceiling effects limit the utility of many established brief cognitive screening tests for detecting and measuring mild delirious states and prodromal disorders. The High Sensitivity Cognitive Screen (HSCS) (Faust & Fogel, 1989), a bedside test taking approximately 25 minutes to administer, may overcome this limitation. The test consists of a selection of moderately difficult items testing six major domains of neuropsychological performance: memory, language, attention/concentration, visual/motor, spatial, and self-regulation and planning. Reliability is adequate, and two separate concurrent validity studies show accuracy rates of 93% and 87% in classifying the overall result of comprehensive neuropsychological testing. HSCS performance is highly correlated with EEG results in medical psychiatric inpatients, and with functional status in HIV-infected community-dwelling subjects. The brevity and convenience of the HSCS and related instruments make them particularly useful in studies of elderly and chronically ill subjects.

AIDS Dementia Complex↗
PubMed1990

Psychotropic drug use in the medically ill: Part I.

Underlying medical illness and drug interactions may make the use of psychotropic agents in some physically ill patients problematic. This overview, published in two parts, discusses six major classes of psychotropic medications (cyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines, neuroleptics, lithium, psychostimulants, and carbamazepine) and examines their use in the setting of specific types of medical illnesses (e.g., cardiovascular, pulmonary, hepatic, and renal disease). Practical considerations in using psychotropic medications in medical-surgical patients, particularly those who are elderly or medically debilitated, receive special emphasis. In part I, the use of cyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines, and buspirone are discussed.

Drug Interactions↗
PubMed1990

Anticonvulsant-responsive panic attacks with temporal lobe EEG abnormalities.

The phenomenology of panic attacks and of complex partial seizures overlap, and at times distinguishing between the two entities is difficult. The authors report five patients with recurrent panic attacks and temporal lobe EEG abnormalities whose symptoms did not warrant a clinical diagnosis of partial seizures but who responded well to anticonvulsant therapy. The cases suggest that focal cortical discharges may trigger panic attacks in some patients in whom an unequivocal diagnosis of epilepsy cannot be made. Electroencephalography and anticonvulsant trials may be appropriate in patients with panic attacks refractory to conventional treatment.

Adolescent↗
PubMed1990

Personality disorder diagnoses and age in inpatients with major depression.

To ascertain the prevalence of personality disorder in elderly patients with major depression and to explore issues of diagnostic practice and bias, the authors reviewed triaxial diagnoses of 2322 psychiatric hospital inpatients with Axis I diagnoses of major depression. They found that Axis II diagnoses had been made in 367 cases (15.8%). Patients older than 65 years of age had a significantly lower rate of Axis II diagnoses. The age effect was greatest for women with comorbid physical illness. In contrast to the age-related decline in rate of Axis II diagnoses in general, the diagnosis of compulsive personality disorder increased with age and comprised 46% of all Axis II comorbidities in patients 65 years or older. Possible explanations and implications for future research are discussed.

Adult↗
PubMed1990

Major depression versus organic mood disorder: a questionable distinction.

DSM-III-R requires the exclusion of causal organic factors to permit a diagnosis of major depression. This exclusion criterion may be unreliable because (1) neither the biomedical nor the historical data base for determining organic causation is operationally specified, (2) rules for weighting various causes of depression are not specified, and (3) the distinction between causal and contributory organic factors often is arbitrary. The exclusion criterion may not be valid because (1) it is unstable with time and (2) clinical criteria for CNS involvement may correlate poorly with neurodiagnostic tests. Both reliability and validity of diagnosis would be improved by keeping Axis I strictly phenomenological and identifying relevant organic factors on Axis III.

Animals↗
PubMed1989

Med-psych units. Financial viability and quality assurance.

Although medical-psychiatric units may have unique advantages for treating patients with combined medical and psychiatric illness, they may be costly to run, and their success requires a sound financial basis. This begins with filling beds and instituting a waiting list, and then setting admission priorities to regulate case mix deliberately to address financial as well as ethical and clinical considerations. Development of short-stay geropsychiatric evaluation services may offset financial problems associated with long stays of elderly patients requiring definitive treatment for complex conditions. Data are presented to show the effectiveness of deliberate regulation of case mix. Regarding quality assurance, key issues include maintaining documentation to meet HCFA standards for DRG exemption, and effectively integrating physical and psychiatric care, with a special focus on drug interactions and psychiatric toxicities of medical drugs. Effective multidisciplinary treatment planning meeting help in this effort, as do periodic walking rounds focusing specifically on pharmacologic issues. Denials of payment by third parties are most likely to be a problem when both the medical and the psychiatric illness are subacute but their interaction requires conjoint inpatient treatment. Prospective work with PROs can minimize retrospective denials.

Combined Modality Therapy↗
PubMed1989

The development and initial validation of a sensitive bedside cognitive screening test.

Brief bedside cognitive examinations such as the Mini-Mental State Examination are designed to detect delirium and dementia but not more subtle or delineated cognitive deficits. Formal neuropsychological evaluation provides greater sensitivity and detects a wider range of cognitive deficits but is too lengthy for efficient use at the bedside or in epidemiological studies. The authors developed the High Sensitivity Cognitive Screen (HSCS), a 20-minute interview-based test, to identify patients who show disorder on formal neuropsychological evaluation. An initial study demonstrated satisfactory test-retest and interrater reliability. The HSCS was then administered to 60 psychiatric and neurological patients with suspected cognitive deficits but without gross impairment, who also completed formal neuropsychological testing. Results of both tests were independently classified as either normal, borderline, or abnormal. The HSCS correctly classified 93% of patients across the normal-abnormal dichotomy and showed promise for characterizing the extent and severity of cognitive dysfunction.

Adolescent↗
PubMed1989

Defining neuropsychiatry: professional activities and opinions of psychiatrist-neurologists with dual certification.

A computer-based search was conducted to locate physicians jointly certified by the American Board of Psychiatry and Neurology in both adult psychiatry and adult neurology since 1960. Eighty-six such physicians were found, and a survey concerning their practice patterns and opinions was conducted. From this survey, it appears that a number of "supraspecialized" neuropsychiatrists are involved in clinical activities that overlap the traditional limits of neurology and psychiatry.

Adult↗
PubMed1989

Integration of general hospital psychiatric services with freestanding psychiatric hospitals.

General medical hospitals and freestanding psychiatric hospitals usually function independently. The authors review the relative strengths and weaknesses of the two settings and suggest a plan for a rational coordination of services. In an efficient integrated system, the general hospital would provide emergency psychiatric services and treat patients with combined medical and psychiatric conditions. The freestanding facility would offer inpatient and outpatient services, as well as partial hospitalization and transitional living arrangements, to psychiatric patients without medical complications. All facilities would share professional staff and data processing capabilities and would have common policies and procedures, reducing the cost of treatment and facilitating patient transfers.

Hospital Bed Capacity, 100 to 299↗
PubMed1989

Depression as a manifestation of obstructive sleep apnea: reversal with nasal continuous positive airway pressure.

Fifty-five patients with obstructive sleep apnea each completed a Zung Self-Rating Depression Scale (SDS), Twenty-five patients (45%) had SDS scores greater than or equal to 50, consistent with depression. The SDS scores did not correlate with age, the number of respiratory events per hour sleep, antihypertensive medication, or the oxygen saturation baseline or nadir. The group with SDS scores of 50 or greater, however, had 68.0 +/- 8.8 respiratory events per hour compared with 47.9 +/- 4.7 in the group with SDS scores under 50 (p less than .05). Nineteen patients who were treated with nasal continuous positive airway pressure completed a follow-up SDS Inventory. After treatment, the SDS scores fell from 60.5 +/- 1.9 to 44.4 +/- 2.6 (p less than .001) in the 11 patients with baseline elevated scores. The authors conclude that obstructive sleep apnea can produce prominent symptoms of depression that appear to be related to the severity of the underlying apnea; furthermore, treatment of obstructive sleep apnea may result in alleviation of these symptoms in certain patients.

Adult↗