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Biomedical subjects

C R Tobias

Publications and source records attributed to C R Tobias.

At least 19 recordsLinked to original sources
PubMed1996

Treatment of insomnia. Getting to the root of sleeping problems.

Insomnia may be periodic and transient, as caused by situational stress, or persistent, as caused by a chronic sleep disorder. Physicians can gain much information concerning the type, probable cause, onset, and duration of insomnia through history taking. A sleep diary may reveal helpful information, and input from the patient's sleeping partner can also be valuable. Complicating disorders, such as heart failure, prostatism, or depression, should be sought and specific treatment prescribed. Chemical dependency, too, requires appropriate treatment. These measures, institution of good sleep-hygiene practices, and behavior modification may resolve sleeplessness. The primary indication for use of hypnotic agents is transient sleep disruption caused by acute stress. When an agent is chosen, onset of action, metabolism, and side effects should be considered, especially in elderly patients. Addictive agents should not be given to patients with substance abuse problems. If insomnia persists, evaluation at a sleep-disorder center is recommended to facilitate design of an appropriate therapeutic regimen.

Anti-Anxiety Agents↗
PubMed1994

Obsessive-compulsive disorder. How to free patients from intrusive thoughts and rituals.

The antidepressants clomipramine hydrochloride (Anafranil), fluoxetine hydrochloride (Prozac), and sertraline hydrochloride (Zoloft) are the main choices for pharmacologic treatment of obsessive-compulsive disorder. Often, drug doses for obsessive-compulsive disorder are higher than for depression, and improvement occurs more slowly and is often only partial. Behavior therapy involving exposure to feared objects or situations and prevention of ritualistic behavior complements pharmacologic treatment. Referral to a behavioral therapist may be necessary to achieve recovery.

Antidepressive Agents↗
PubMed1992

Pharmacologic treatment strategies for the depressed, poorly responsive patient.

Treatment-resistant depression implies a failure of response to an ample dose of antidepressant medicine, prescribed over a sufficient length of time. Assessing drug levels in the blood is often helpful in confirming the adequacy of antidepressant dosages. Augmentation of the pharmaceutical activity can be achieved by coadministration of lithium, triiodothyronine, and/or stimulants. Neuroleptics are also prescribed with the antidepressant when psychotic features accompany depression. Such enhancements to drug efficacy are usually an advantage over beginning a new medication because of shorter response time. When a decision is made to change the antidepressant, a structurally different option is more likely to induce a remission than a medication of similar configuration. Electroconvulsive therapy is the most powerful treatment choice for depressed patients, especially when suicidal or psychotic features are present.

Antidepressive Agents↗
PubMed1992

Preventing suicide in older people.

Prompt recognition of suicidal intent can prevent suicide in the elderly. Some psychiatric disorders, such as depression, psychoses and organic brain syndromes, can predispose these persons to suicide, as can medical disorders that result in pain, disability or dysfunction. Other factors that increase the risk for suicide include chemical dependency and changing life events. Anti-depressant medications with a low anticholinergic and sedative profile are preferred because of age-related physiologic changes. Electroconvulsive therapy is reserved for serious cases.

Aged↗
PubMed1990

Dementia: what to do.

Dementia is a syndrome of acquired intellectual deterioration that interferes with personal or social functioning. Diagnosis requires historical information from the family and the mental status evaluation of orientation, recent memory, comprehension, calculation, and abstraction. Most dementias create permanent, even progressive cognitive deterioration, yet there are some presentations for which remission exists. Common reversible conditions include depression, drug toxicity, normal-pressure hydrocephalus, hypothyroidism, subdural hematoma, and neoplasm. Screening laboratory studies consist of urinalysis, chemistry profile, blood count, thyroid survey, vitamin B12 and folate measurements, serology, chest roentgenogram, computerized tomographic scan of the head, electroencephalogram, and electrocardiogram. Treatment focuses on potential reversibility, psychosocial issues, restoring deficits, and specific symptoms.

Cognition Disorders↗
PubMed1989

Dementia in the elderly.

When are confusion and forgetfulness transient signs of normal aging, when are they signs of depression or a medical illness, and when are they signs of dementia? The authors describe clinical features and diagnostic studies that help establish the presence of dementia and discuss ways of coping with both remediable and less treatable types.

Aged↗
PubMed1989

Alcoholism in the elderly. How to spot and treat a problem the patient wants to hide.

Alcoholism is a disease that warrants a complete medical workup and vigorous intervention in all age-groups, including the elderly. Increased awareness of the problem, with early diagnosis and treatment, can reduce mortality and morbidity. Alcoholics are at risk for relapse, so physicians should be patient and positive in their approach. Especially in the elderly, obtaining a list of all prescribed and over-the-counter medications used is an important starting point. Nonessential drugs should be discontinued and use of any others closely monitored. If a withdrawal syndrome results from discontinuation of alcohol, thiamine, multivitamins, and sedatives should be prescribed as clinically indicated. Treatment of any underlying psychiatric disorder is important. Psychosocial intervention is essential in dealing with recovering elderly alcoholics to overcome loneliness and to enhance sobriety. A formal rehabilitative effort is mandatory. Long-term rehabilitation focuses on group support and may include use of disulfiram (Antabuse).

Aged↗
PubMed1988

Psychiatric disorders in the elderly. Psychopharmacologic management.

Psychiatric management of elderly patients is a challenging task because of the many age-related physiologic changes and medical problems in this population. Thorough patient evaluation is essential to rule out somatic disorders and determine underlying causes. Somatic complaints must be taken seriously, even if a patient is receiving treatment for a psychiatric disorder. Psychotropic therapy is used mainly for controlling depression, agitation, and psychotic symptoms. If psychiatric symptoms persist or become worse, psychotropics should be discontinued to prevent possible drug toxicity (eg, anticholinergic delirium) and psychiatric consultation should be requested.

Aged↗
PubMed1988

The violent patient: what to do?

Violence is a common clinical problem that must be quickly assessed to be properly managed. The examiner should keep at a safe distance from the patient and conduct the interview in a firm but nonthreatening manner. Verbal intervention, pharmacotherapy, and occasionally, physical restraints are indicated as a first-line approach while treatment of the underlying medical or psychiatric abnormality is initiated. Once the violent patient is under control, management includes thorough diagnostic assessment, pharmacotherapy, careful psychotherapy, and mobilization of community resources.

Humans↗
PubMed1988

Evaluation and management of self-mutilation.

Instances of deliberate self-injury are observed in both psychotic and nonpsychotic individuals. Patients with command hallucinations, religious preoccupations, substance abuse, and social isolation are the most vulnerable. Persons who request unnecessary surgical procedures for bizarre reasons also are at high risk. Such behavior constitutes a medical, surgical, and psychiatric emergency. A thorough psychiatric evaluation is mandated in every case. Vigorous psychiatric treatment and follow-up care involving the full range of pharmacologic, somatic, and psychologic interventions are indicated.

Adult↗
PubMed1988

Depression and alcoholism: clinical considerations in management.

When alcohol abuse occurs with depression, both the substance abuse and the mood disorder necessitate treatment. These conditions may have some similar manifestations, making differential diagnosis difficult. Depressed alcoholics report more previous treatment for substance abuse, withdrawal symptoms, and marital problems than those without depression. They also incur greater loneliness, unemployment, and social ineptness. Depressive symptoms found commonly in this group include work inhibition, guilt, self-disgust, dissatisfaction, and social disinterest. A history of depression among relatives favors a dual diagnosis of alcoholism and depression. Distinguishing those alcoholics with specific depressive illness enhances the therapeutic efficacy. Alcohol abusers need treatment, but those with concomitant depression persisting well beyond detoxification often require antidepressant medications. In long-term care, lithium may reduce alcohol-related rehospitalizations. A strong doctor-patient relationship with or without pharmacotherapy promotes continuation in a therapeutic regimen. Involvement in Alcoholics Anonymous and disulfiram maintenance therapy are other deterrents to drinking relapse.

Alcoholism↗
PubMed1988

A preventive approach to the suicidal patient.

Physicians may have the opportunity to prevent suicide. An awareness of suicide risk factors, such as depression, alcoholism, drug abuse, schizophrenia, and chronic pain or disease, may facilitate suicide prevention. Recognition of acute and chronic suicidal vulnerability occurs through direct questioning. Psychiatric consultation is indicated for patients exhibiting clear self-injury risk, as exemplified by expressed suicide intent, an overt plan for death, or a "gesture." Hospitalization is usually recommended for socially isolated patients presenting with overt suicidal ideation, complicated by injurious self-harm, encephalopathy, or substance abuse. Family involvement and a "no-suicide" contract with the patient, coupled with close outpatient follow-up appointments, should suffice for those exhibiting milder or transient thoughts of suicide without manifest intent to die.

Adult↗
PubMed1988

Post-traumatic stress disorder in Vietnam veterans.

Post-traumatic stress disorder evolved from the concepts of shell shock and traumatic war neurosis. In Vietnam veterans, the disorder is associated with unemployment, marital discord, alcoholism and increased autonomic system response to perceived symbols of war trauma. A combination of psychotherapy and pharmacotherapy is the recommended treatment.

Humans↗