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Biomedical subjects

C C Colenda

Publications and source records attributed to C C Colenda.

At least 37 records · Page 2Linked to original sources
PubMed1997

Phototherapy for patients with Alzheimer disease with disturbed sleep patterns: results of a community-based pilot study.

We examined the entraining effects of phototherapy delivered by light visors on disturbed sleep patterns of community-dwelling research subjects with Alzheimer disease (AD). The pilot project used a single subject design and activity monitoring as the primary outcome measures. The protocol consisted of a 5-day baseline monitoring period, followed by 10 consecutive days of phototherapy (2,000 lux of full spectrum bright light) delivered by light visors for 2 hours each morning; this was followed by an additional 14 days of activity monitoring. Cosinor analyses found no consistent changes in acrophase, mesor, or amplitude. Observed changes in acrophase were consistent with phase advancement of the rest-activity cycle and consistent with the biological intervention. Changes in the number of nighttime awakenings were not found. One subject had a significant increase in total sleep time, whereas another had a significant decrease in total sleep time. Failure to find a consistent biological effect of light on AD subjects may be secondary to: (1) insufficient duration of light exposure; (2) timing of light administration (given at a time when circadian rhythm is refractory to the effects of light); (3) advanced stages of AD making the Y circadian pacemaker in the suprachiasmatic nucleus of the hypothalamus insensitive to the biological effects of light; and (4) inadequacy of light visors as a means of providing light.

Activities of Daily Living↗
PubMed1997

Physicians' judgments of the risks of cardiac procedures. Differences between cardiologists and other internists.

OBJECTIVES: The authors compared judgments of the population risks of invasive cardiac procedures made by cardiologists and other internal medicine physicians. Our main hypotheses were that cardiologists' judgments would differ from those made by the other physicians and that cardiologists' judgments would be more accurate than those of other physicians. METHODS: This was a cross-sectional survey of senior staff and physician-trainees at two teaching hospitals affiliated with a US medical school, Emergency Department physicians at a community hospital in the same metropolitan area, and senior staff and trainees at two teaching hospitals affiliated with a UK school. Judgments of the risks of severe morbidity and death due to Swan-Ganz catheterization, cardiac catheterization, percutaneous coronary angioplasty, and coronary artery bypass grafting were assessed. RESULTS: Nineteen cardiologists judged the risks of severe morbidity due to all procedures and the risks of death due to all procedures except coronary artery bypass grafting to be significantly lower than did the 78 other internists. Cardiologists more frequently made accurate judgments of the rates of morbidity and death due to cardiac catheterization than did the other internists; other internists more frequently made accurate judgments for the rates of morbidity due to Swan-Ganz catheterization. CONCLUSIONS: Disagreements about the risks of procedures may arise from a paucity of published data, or from an over-supply of confusing data.

Angioplasty, Balloon, Coronary↗
PubMed1997

Mental health and health care utilization in geriatric primary care patients.

OBJECTIVE: This study examines the effect of mental health factors on health care utilization in a group of community dwelling elderly subjects followed in a primary care setting. METHOD: Data on utilization was obtained prospectively from computerized billing records for a one-year period following completion of a structured survey. Relationships between variables were characterized by Spearman's rank correlation. Multivariate linear regression modeling was employed to relate health care utilization, as measured by total cost, to the baseline variables. RESULTS: No significant relationship was found between mental health measures and health care utilization as measured by total costs in this elderly population. However, total costs were found to be related to medical comorbidity and total daily medication use. CONCLUSION: The present study did not find the relationship of psychiatric distress and increased use of health care services to apply to a group of community dwelling elderly. Future research will need to focus on larger data sets and improvement of models that attempt to examine the relationships between mental health and health care utilization in the elderly.

Aged↗
PubMed1996

Clinical variables influencing treatment decisions for agitated dementia patients: survey of physician judgments.

OBJECTIVE: To better understand primary treatment recommendations and the variables that might influence treatment decisions of physicians who treat agitated dementia patients. DESIGN: A written cross-sectional survey of three physician groups (geriatric psychiatrists, primary care physicians, and neurologists) who typically treat agitated dementia patients in community settings. We used a written clinical vignette describing a home-bound, agitated dementia patient to ask respondents to provide information regarding their primary treatment recommendation and to estimate the degree to which clinically relevant variables might influence their treatment recommendation. Using principal component analysis, the original set of clinical variables was collapsed into a smaller set of composite factors that better defined the fundamental constructs of the variables that influenced decision making. Analyses compared primary treatment recommendations and factors influencing treatment recommendations by physician groups. PARTICIPANTS: The pool of survey respondents consisted of a random selection of 207 primary care physicians from western North Carolina, 147 geriatric psychiatrists obtained from the roster of the 1991 American Association for Geriatric Psychiatry, and 120 neurologists obtained from the roster of the American Board of Medical Specialties. The response rate was 65% for geriatric psychiatrists, 38% for primary care physicians, and 33% for neurologists. RESULTS: Differences in primary treatment recommendations by physician group were not found. Physicians, regardless of specialty, recommended neuroleptic medications as their primary intervention. When medication classes were collapsed into a single category, medications as a primary intervention exceeded 55% for all physician groups. Twenty-two percent of all respondents recommended psychosocial interventions as primary treatment strategies. The principal component analysis of clinical variables influencing treatment recommendations solved for five components that accounted for 64% of the variance. Comparing the five components by specialty groups failed to find significant differences, except for Factor 5, the "Hassle Factor." Primary care physicians were more likely to indicate that this component influenced their decision making than were the other physician groups. CONCLUSIONS: The findings indicate that physicians, regardless of specialty, are likely to use medication and to weight clinically relevant information in a similar fashion when managing agitated dementia patients.

Aged↗
PubMed1996

Riding a Trojan horse: computerized psychiatric treatment planning using managed care principles.

Efforts to curtail health care costs have triggered new emphasis on resource management and accountability, entailing explicit documentation of the rationale for treatment and the resulting outcome of care. This article discusses the development of a computerized psychiatric treatment planning database that embodies principles and language of managed care, including specific admission criteria, severity ratings, and time frames for completion of interventions. The program is designed to balance goals of clinical utility, usefulness of the database as a tool for utilization review, quality improvement, and health services research, while providing an interface that is acceptable to clinicians.

Case Management↗
PubMed1996

A statistical model predicting the seizure threshold for right unilateral ECT in 106 patients.

Titration of the electroconvulsive therapy (ECT) stimulus to the patient's convulsive threshold is the only way to directly assess the patient's seizure threshold. This technique is presently practiced by 39% of ECT providers, according to a recent survey. Because multiple variables influence the seizure threshold in patients, multivariate statistical methods may provide a useful strategy to determine which variables exert the most influence on convulsive threshold. A multivariate ordinal logistic model of seizure threshold was developed on an experimental group of 66 consecutive patients undergoing titrated right unilateral (RUL) ECT for major depression. The accuracy of the model was cross-validated on a second group of 40 patients undergoing similar RUL ECT procedures. The final multivariate ordinal logistic regression model for the seizure threshold level (STL) was significant (Likelihood ratio chi 2 = 54.115; p < 0.0001:R2 = 0.313). Increasing age, African-American race, and longer inion-nasion distances (p < 0.06) predicted higher STL. Female gender was associated with a lower STL. The ability of the final model to accurately predict STL for the validation group was fair (pairwise correlation was 0.576; p < 0.001). The model did well for predicting lower STL, but fared poorly for higher STL. In conclusion, modeling STL may help establish the relative contribution of variables thought to be important to seizure threshold. However, STL models remain impractical for clinical applications in estimating seizure threshold at this time, and empirical stimulus titration should be used.

Adult↗
PubMed1996

Ictal EEG regularity declines during a course of RUL ECT.

Twenty depressed patients (4 men, 16 women; mean age 67 years) received right unilateral (RUL) electroconvulsive therapy (ECT). The ictal electroencephalogram (Fp1-A1) was blindly rated on a 7-point scale for regularity of morphology at treatments two, four, and six. Seizure regularity declined during the course of ECT.

Aged↗
PubMed1995

Assessing and treating anxiety in elderly persons.

Although anxiety disorders appear to occur less frequently in elderly persons, subsyndromal anxiety and anxiety associated with other medical and psychiatric disorders are significant sources of morbidity. Theories of etiology of anxiety range from the psychodynamic to the neurobiologic. Treatment of anxiety syndromes hinges on a thorough diagnostic evaluation, with attention to the tendency of older adults to prefer somatic descriptors and to view psychiatric illness as stigmatizing. The efficacy of nonpharmacologic treatment strategies such as relaxation training and psychotherapy for elderly anxious patients has not been well researched, but these interventions have been reasonably successful with younger adult populations and avoid the potential for harmful side effects of medication. Pharmacologic treatment strategies can be effective when used with appropriate caution.

Aged↗
PubMed1992

Recall of clustered and unclustered word lists in elderly adults.

We present descriptive data for alternate forms of clustered and unclustered word list recall in 102 healthy elderly adults and test results for 11 patients with Parkinson's disease. The word list test provided a relatively stable measure of verbal memory. Alternate forms were equivalent except for a tendency of the unclustered list of Form 1 to be easier than those of the other three forms. Verbal intelligence, total word recall, and the ability to cluster related words at recall were related significantly. There were modest effects of education on word recall; female subjects tended to recall more words than males.

Aged↗
PubMed1991

Effects of buspirone and alprazolam on the cognitive performance of normal elderly subjects.

OBJECTIVE: To increase understanding of the potential in elderly persons for disability related to behavioral side effects of anxiolytic medications, cognitive and psychomotor effects of clinical doses of buspirone and a popular intermediate-acting benzodiazepine, alprazolam, were examined in carefully screened, healthy elderly subjects. METHOD: Sixty subjects recruited through community organizations and newspaper advertisements and screened on the basis of history, physical examination, and laboratory studies were randomly assigned to one of three drug treatment groups. After 2 days of washout placebo, subjects were given 0.25 mg t.i.d. of alprazolam, 5 mg t.i.d. of buspirone, or placebo three times a day for a total of 14 days in a double-blind design. Behavioral assessments were completed beginning 1 hour after ingestion of medication on the second washout placebo day, day 1 of the treatment period, and day 14 of the treatment period. Tests included the continuous performance test, recall memory for word lists, digit-symbol substitution, retention of pictorial stimuli over 1 hour, the Profile of Mood States, and subjective ratings of mental status. RESULTS: Buspirone did not affect reaction time, vigilance, psychomotor speed, or memory function. Alprazolam had minimal effects on vigilance, psychomotor speed, and memory on the first treatment day and had no effects after repeated doses. CONCLUSIONS: Buspirone did not produce behavioral side effects that could lead to disability, and alprazolam had minimal side effects. Because the patients were carefully screened, it is unclear whether these medications in the doses used would have more side effects in less healthy elderly patients.

Aged↗
PubMed1991

Antecedents and interventions for aggressive behavior of patients at a geropsychiatric state hospital.

Aggressive geropsychiatric patients pose major problems for long-term care facilities. Two exploratory surveys at a geropsychiatric state hospital, separated by brief programs of inservice training on managing aggressive patients, examined several aspects of aggressive behavior and staff interventions. Major findings included a stable overall prevalence of aggressive behavior in both survey periods; a persistently higher prevalence of aggression and a higher rate of physical aggression among dementia patients than among other patients; and staff-patient exchanges as a major triggering event for aggression. In the survey period after the inservice training, staff interventions remained similar for nondementia patients; however, for dementia patients, interpersonal interventions were used less frequently, and p.r.n. medications, alone or in combination with seclusion or restraint, were used more often.

Aged↗
PubMed1990

Antiarrhythmic properties of amitriptyline.

Clinical studies and case reports have shown that nortriptyline and imipramine exert type 1 antiarrhythmic properties when plasma concentrations are therapeutic, indicating that clinical reservation against their use in cardiac patients may be overstated. The clinical cardiac effects of amitriptyline have not been extensively reported. The case I have reported details the electrophysiologic record of the beneficial and safe use of amitriptyline in a patient with severe cardiac arrhythmias and organic affective disorder.

Aged↗