Biomedical subjects
Publications and source records attributed to C G Lyketsos.
In a chart review at a hospital's infectious disease AIDS clinic, manic syndromes affected 8% of patients who had AIDS. Of the 14 patients with manic episodes, those without a family or personal history of mood disorder presented later in the course of HIV infection and had a higher prevalence of comorbid dementia.
The Maryland Psychiatric Society (MPS) Public Psychiatry Committee, concerned with the preparedness of Baltimore mental health facilities to deal with the accelerating human immunodeficiency virus (HIV) epidemic, surveyed public sector mental health facilities. The survey results indicated that the number of HIV-infected patients is greatly underestimated. Care providers acknowledged awareness of the problem and wanted more education.
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The psychopathology and disabilities of a group of institutionalised elderly schizophrenics were compared with those of a group of non-schizophrenic elderly, and with younger schizophrenics reported in a parallel study and in the literature. Elderly schizophrenics showed significantly more psychopathology and disability than the non-schizophrenic elderly; however, they exhibited less psychopathology than younger schizophrenics. Disability among elderly schizophrenics was not correlated with chronicity of institutionalisation or psychopathology. There was a suggestion that disability among elderly schizophrenics may be due to organic deterioration.
This paper reports studies of patients with the following disorders: peptic ulcer, hypertension, bronchial asthma, irritable bowel syndrome (IBS), ulcerative colitis (UC), urticaria, psoriasis and alopecia. The investigations focused on dysthymic states, measured by Foulds' Scale of Anxiety and Depression (SAD) and--except for the first three disorders--the Present State Examination (PSE). On the SAD, all the above groups scored significantly higher than somatically ill controls in anxiety, and all except ulcer patients scored significantly higher in depression. The PSE designated more than half of these patients as cases, except in the psoriasis group. Most patients were assigned to the PSE syndromes of anxiety states or neurotic depression, with the former being more common in UC and urticaria, and the latter more common in IBS, alopecia and rheumatoid arthritis. The variation within skin diseases and within gastrointestinal diseases suggests that neurotic symptoms are typical of each disease rather than of the system involved in the disturbance.
Two experimental groups of patients with ulcerative colitis (UC) and irritable bowel syndrome (IBS) were compared for hostile personality characteristics and dysthymic states with physically ill patients. Both experimental groups were found to be less dominant, more intropunitive, more anxious and more depressed than the control group. IBS patients, however, were more dominant and less intropunitive than UC patients. Low dominance has been associated with psychosomatic illnesses, and high intropunitiveness with neurotic formation. Both UC and IBS patients have been found to be severely neurotic, a fact reflecting the concurrence of the psychosomatic and neurotic defences in these diseases. More IBS patients had premorbid psychiatric symptoms in comparison with controls and UC patients.
Three experimental groups of patients with urticaria, psoriasis and alopecia were compared for hostile personality characteristics, states of anxiety and depression, neurotic syndromes and stress with a control group of patients with other skin diseases. The patients from each experimental group were found to be less dominant, more intropunitive, more extrapunitive and more neurotic than the control group. The following neurotic syndromes differentiated the experimental groups: non-specific anxiety states in urticaria patients; neurotic depression in the patients with alopecia, and a variety of neurotic syndromes in the psoriasis patients. All experimental groups scored significantly higher than the controls in stress experienced during the year preceding the onset or the exacerbation of the illness.
An investigation of eating disorders in a population of chronic schizophrenic patients confirmed that there is a distinction between eating disorders of psychotics and eating disorders of the young. All the DSM-III criteria of eating disorders, except one, were observed among the psychotics although no patient fulfilled the necessary criteria for an eating disorder diagnosis except for one anorexic woman. All varieties of schizophrenic eating disorder were reported: in two-fifths of the patients eating disorders were associated with delusions and in one sixth with hallucinations; more than half of the patients had deviant eating behaviour which was not associated with any thought or perceptual disorders. Schizophrenic eating disorders were common, yet not disturbing to the social life of the open mental hospital or to that of the community surrounding it.
Patients with bronchial asthma were compared with physically ill patients as to personality traits and dysthymic states. Asthmatics were less dominant and more intropunitive, more anxious and more depressed than the control group. Low dominance or dependent social attitude and inhibited hostility was correlated with low vital capacity (FVC).
Alcohol consumption as a cofactor in the progression of HIV infection was examined in 1,446 homosexual and bisexual HIV + men enrolled in the Multicenter AIDS Cohort Study who had a minimum of three visits. Two measures of drinking were employed: initial level, and pattern during the study period. Outcome measures included AIDS-related symptoms and AIDS diagnosis. Level of drinking at entry to the study was not significantly associated with either AIDS-related symptoms at final visit or with AIDS diagnosis. However, men who decreased drinking were more likely to report thrush, fatigue, weight loss, and diarrhea at their final visit. Most likely, these men decreased drinking as a result of failing health, not because their drinking pattern influenced symptom onset. These data support earlier reports that found no relationship between alcohol consumption and progression to AIDS.
This article reviews the literature on the classification and treatment of psychiatric morbidity associated with infection from the human immunodeficiency virus (HIV). The psychiatric disorders seen in HIV-infected patients are formulated by using one of the following four perspectives as treatment guides: 1) the syndromal or disease perspective, 2) the dispositional or personality perspective, 3) the behavioral or addictive perspective, and 4) the life story perspective.
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Major depression afflicts from 15% to 31% of patients with Alzheimer's disease (AD). The charts of 137 patients with AD were reviewed to assess the association between several variables and the risk of developing major depression. Thirty-eight patients (28%) had major depression. A family history of mood disorder was associated with a significantly increased risk for major depression, but this was only true in women (relative of odds = 2.82,95 confidence interval from 1.19 to 6.69). There was no relationship between major depression and a personal history of depression, younger age at onset of AD, history of substance use disorder, institutionalization, and marital status. These results suggest that the relationship between family history and depression in AD is more complex than previously thought.
The study sought to determine the effectiveness of a model program of psychiatric care for human immunodeficiency virus (HIV)-infected patients. This was a cohort study of 126 HIV-positive outpatients referred for psychiatric evaluation and treatment (average follow up of 14 months) in a HIV-dedicated primary-care outpatient clinic in the inner city. A global outcome measure (encompassing symptom relief, functioning, and HIV-risk behaviors), and a measure of abstinence from alcohol and illicit substances were used. Fifty percent of patients improved, with 19% "nearly well" at follow-up. Abstinence was achieved 48% of the time. Good compliance with treatment and the absence of injection drug use were the primary predictors of good outcomes. Of the compliant patients, 94% improved, with 45.7% being nearly well. Psychiatric treatment of HIV-infected patients is effective when located in the HIV primary-care setting and administered by a multidisciplinary team under the direction of a psychiatrist, using evidence-based interventions.
The objective of this study was to determine the relative efficacy and safety of fluoxetine and amitriptyline in the treatment of major depression complicating Alzheimer's disease (AD). The sample included 37 patients with AD and major depression. The study design was a double-blind, fixed-dose, randomized clinical trial with 45 days of follow-up. The outcome measures were the Hamilton Depression Rating Scale (Ham-D), the Mini-Mental State Exam (MMSE), and the number of dropouts from each arm of the study. Efficacy was similar for fluoxetine and amitriptyline. At Day 45, there was a mean 9.4-point reduction in Ham-D scores (t[df,62] = 9.68, P < 0.0001) and a 2.4-point mean increase in MMSE scores as compared to baseline (t[df,2] = 2.69, P = 0.009). Eleven (58%) of the amitriptyline-treated patients dropped out, compared with 4 (22%) of the fluoxetine-treated patients (chi 2[df,2] = 8.9, P = 0.017). The authors conclude that antidepressant treatment for major depression complicating AD is effective. While fluoxetine and amitriptyline are equally effective, fluoxetine is better tolerated.
Great strides have been achieved in recent years in the detection and treatment of major depressive disorder (MDD) in primary care settings. Little is known about the types or patients with MDD seen in primary care as compared with those seen in psychiatric office practice. Few studies have compared clinical outcomes after treatment with antidepressants in these two settings. In Argentina, the authors conducted an open-label treatment study of MDD patients in primary care (n = 469) and psychiatric office practice (n = 299). The patients were compared on baseline sociodemographic and clinical variables. These same patients were treated with sertraline 50-100 mg per day for 8 weeks. At baseline, the patients in psychiatric office practice were younger, more likely to abuse alcohol, less likely to have comorbid medical disorders, and more likely to have failed a prior treatment for depression during the current episode. The two groups did not differ significantly on depression severity or in depressive symptom profile on the Hamilton Depression Rating Scale (Ham-D). After 8 weeks of treatment, mean Ham-D scores were reduced comparably in both groups, from about 25 to about 10. Rates of adverse events were 14%-29%, depending on the follow-up interval. Adherence with treatment was high in both groups (over 95%). The patients in primary care and psychiatry office practice are similar in several ways. Significant reductions in depressive symptoms are possible in both settings, in large numbers of patients, by using doses of sertraline in the 50-100 mg range.
Alzheimer's disease and frontotemporal dementia are two of the most common types of degenerative dementia. In conjunction with a complete neuropsychiatric examination, the Executive Interview, Mini-Mental State Exam, Alzheimer's Disease Scale, Pick's Disease Scale and the Informant-Based Questionnaire have been used to distinguish between these two disorders on clinical grounds. In a review of two studies, scores from these rating scales are subjected to receiver operator characteristic curve analysis to determine the cut-off value for each scale which yields the highest sensitivity and specificity with regard to differentiating between Alzheimer's disease and frontotemporal dementia. Finally, the Informant-Based Questionnaire is discussed and compared to each rating scale to demonstrate the important features and limitations of each.