Biomedical subjects
Publications and source records attributed to D A Casey.
Obsessive-compulsive disorder is a fascinating and troubling clinical problem that is now believed to be relatively common. New approaches to research are beginning to unlock its secrets and explore its biological underpinnings. Drugs such as fluoxetine hydrochloride (Prozac) and clomipramine hydrochloride (Anafranil) now offer hope for improvement in the lives of affected persons.
An elderly woman with symptoms of depression and an AIDS delusion was found also to have pancreatic carcinoma. I have discussed her case in conjunction with organic affective disorder, the evaluation of depression in the elderly, and suicide in the elderly.
Data from death certificates in Kentucky in 1987 and 1988 for persons 65 years old and older were analyzed. There were 205 suicides in the 2-year study period. Suicide rates were higher for the elderly than for any other population group. White men, the group at highest risk, committed approximately 80% of the suicides in the elderly group. Suicide among minorities was rare. Self-inflicted gunshot wounds accounted for 88% of the suicides in the elderly group. Despite their high risk of suicide, elderly white men are underrepresented in terms of psychiatric admissions.
Cognitive therapy as applied to the short-term psychiatric inpatient unit is explored. The authors provide an overview of the cognitive model and the utilization of cognitive-behavioral therapies for a variety of diagnostic categories. Adaptations of cognitive techniques to the inpatient unit are described and illustrated through case presentations.
November is national Alzheimer's disease month. This disorder involves not only cognitive dysfunction but also psychiatric symptoms. Alzheimer's disease places a tremendous burden on caregivers. These psychosocial factors are often the causes of institutionalization.
Suicide is more common among the elderly than any other age group. Elderly white males constitute the group at highest risk for suicide in the United States. Older persons typically choose means of high lethality in suicide attempts. Previous suicide attempts, bereavement, alcohol abuse, depression, psychosis, physical illness, and social isolation are all risk factors for suicide in the elderly. Clinicians who treat this patient group should have a high index of suspicion for suicidal ideation.
Paranoid disorders in the elderly are relatively common and represent a variety of diagnostic categories. Appropriate treatment depends on careful diagnostic assessment. Therapy of concomitant medical disorders, psychiatric medications, and psychotherapy all play a role in the management of these patients.
Cases are presented which show the clinical utility of recording an electrocochleographic response to bone-conducted stimuli. The procedure is fraught with problems of acoustic control and artifact generation, but has distinct although limited values in clarifying masking dilemmas in patients with bilateral hearing loss.
Perilymph fistulas are a known cause of sudden hearing loss. The two cases presented illustrate round window ruptures secondary to acoustic trauma. The important considerations are early diagnosis and treatment, the possibility of associated congenital anomalies, and future protection against sound.
Little is known about personality disorders in the elderly. Review of 100 consecutive inpatient admissions revealed that 7% [corrected] received an Axis II diagnosis of personality disorder. Sixteen percent received a diagnosis of personality disorder trait.