PubMed Health⌕ Search

Biomedical subjects

D A Solomon

Publications and source records attributed to D A Solomon.

At least 37 records · Page 2Linked to original sources
PubMed1996

Serum lithium levels and psychosocial function in patients with bipolar I disorder.

OBJECTIVE: This study compared the effect of two different serum lithium levels on the psychosocial functioning of patients with bipolar I disorder. METHOD: Ninety patients with bipolar I disorder were enrolled in a prospective, double-blind, maintenance trial of lithium. The patients were randomly assigned to treatment with doses of lithium adjusted to achieve a serum lithium concentration of either 0.8 to 1.0 mmol/liter (standard) or 0.4 to 0.6 mmol/liter (low). The Longitudinal Interval Follow-Up Evaluation was used to assess psychosocial functioning in the areas of work, interpersonal relationships, and global functioning. All observed values were analyzed with a mixed-effects analysis of covariance. Independent variables included treatment group (low or standard lithium serum level), relapse status, socioeconomic status, time from random treatment assignment to assessment, termination of protocol before or after relapse, length of remission before random treatment assignment, polarity of the last mood episode before random treatment assignment, and number of mood episodes in the 3 years before random treatment assignment. RESULTS: Relapse was associated with large negative effects on psychosocial functioning. Patients in higher socioeconomic brackets had better psychosocial functioning than did those in lower brackets. Patients receiving lithium doses that achieved standard serum levels had better psychosocial functioning than those receiving doses that achieved low serum levels; this effect was partially but not wholly mediated through relapse prevention. CONCLUSIONS: For patients with bipolar I disorder, standard serum lithium levels may enhance psychosocial functioning, above and beyond the effects of relapse prevention.

Adolescent↗
PubMed1996

Does major depression result in lasting personality change?

OBJECTIVE: Individuals with a history of depression are characterized by high levels of certain personality traits, particularly neuroticism, introversion, and interpersonal dependency. The authors examined the "scar hypothesis," i.e., the possibility that episodes of major depression result in lasting personality changes that persist beyond recovery from the depression. METHOD: A large sample of first-degree relatives, spouses, and comparison subjects ascertained in connection with the proband sample from the National Institute of Mental Health Collaborative Program on the Psychobiology of Depression were assessed at two points in time separated by an interval of 6 years. Subjects with a prospectively observed first episode of major depression during the interval were compared with subjects remaining well in terms of change from time 1 to time 2 in self-reported personality traits. All subjects studied were well (had no mental disorders) at the time of both assessments. RESULTS: There was no evidence of negative change from premorbid to postmorbid assessment in any of the personality traits for subjects with a prospectively observed first episode of major depression during the interval. The results suggested a possible association of number and length of episodes with increased levels of emotional reliance and introversion, respectively. CONCLUSIONS: The findings suggest that self-reported personality traits do not change after a typical episode of major depression. Future studies are needed to determine whether such change occurs following more severe, chronic, or recurrent episodes of depression.

Adult↗
PubMed1996

Polypharmacy in bipolar I disorder.

There are currently three mood stabilizers available for the maintenance treatment of patients with bipolar I disorder: lithium, valproate, and carbamazepine. Unfortunately, monotherapy with each of these conventional agents often fails. To improve outcome, clinicians utilize polypharmacy. Although the efficacy of this practice is largely unknown, because of the lack of controlled studies, data from the United States and Europe indicate polypharmacy is the rule rather than the exception. The few controlled trials that have been conducted indicate that (1) the specific combination of lithium plus imipramine provides no advantage over lithium monotherapy (notwithstanding the inadequacy of lithium monotherapy); (2) the specific combination of lithium and the depot neuroleptic flupenthixol provides no advantage over lithium monotherapy; and (3) the combination of lithium plus carbamazepine may be as effective as lithium plus haloperidol for acute and continuation treatment. Most of the literature on polypharmacy consists of case reports, retrospective chart reviews, and open-label prospective studies, and describes the use of numerous combinations of medications, including lithium plus valproate, lithium plus carbamazepine, and valproate plus carbamazepine. Preliminary findings suggest these combinations may be effective, and that clozapine and high-dose levothyroxine may each be useful as well when combined with other drugs. Further research is necessary to formally evaluate whether these drug combinations are more effective than monotherapy. Until such studies are completed, certain general principles regarding side effects, pharmacodynamics, and pharmacokinetics should be kept in mind when prescribing two or more medications concurrently.

Bipolar Disorder↗
PubMed1995

Course of illness and maintenance treatments for patients with bipolar disorder.

BACKGROUND: Both naturalistic studies and treatment research on bipolar disorder are reviewed to describe its clinical course, the need for maintenance therapy, the efficacy of current pharmacologic prophylaxis, and the empirical basis for more comprehensive approaches to treatment. METHOD: Articles were identified through computerized literature searches and from bibliographies of published studies, review articles, and textbooks. RESULTS: Bipolar disorder is marked by multiple relapses and recurrences, as well as significant interepisode psychopathology. Within 1 year of recovery from a mood episode, half of all patients will have suffered a second episode. Various clinical and demographic variables have been investigated as risk factors for recurrence. Although lithium represents the single greatest advance in the treatment of this disease, it is clear that a substantial number of patients fail lithium prophylaxis, including those with a high frequency of prior episodes, mixed (dysphoric) mania, comorbid personality disturbance, and rapid cycling. The foremost pharmacologic alternatives to lithium are the anticonvulsants carbamazepine and valproate. Increased recognition of the psychosocial sequelae of bipolar disorder and the limitations of pharmacotherapy alone have led to the investigation of psychosocial interventions. These preliminary studies are small in number and of poor quality for the most part, but have nevertheless yielded positive findings. CONCLUSION: Although lithium often fails to meet the clearly established need for prophylactic treatment, there is little evidence from rigorous clinical trials to support the wide-spread use of anticonvulsants in maintenance therapy. Treatment research should further examine these medications and the use of psychosocial treatments as adjuvants to pharmacotherapy.

Adult↗
PubMed1994

Disability evaluation in building-related health problems.

Assessing impairment and disability in workers with suspected sick building syndrome (SBS) is problematic because most workers do not have permanent impairment. Symptoms are so nonspecific and prevalent in the general population that an excessive number of workers in the building must be afflicted before a diagnosis of SBS can be entertained. Removal of the worker from the workplace should result in resolution of symptoms. Because end-organ dysfunction is not detected by examination or laboratory testing impairment by definition does not exist. However, a worker with SBS may be disabled without impairment.

Air Pollution, Indoor↗
PubMed1993

Continuation and maintenance pharmacotherapy for unipolar and bipolar mood disorders.

There is evidence that the risk for recurrence increases with each additional mood episode. Substantial data show that the probability of relapse and recurrence in both unipolar and bipolar disorders can be decreased by extended pharmacologic treatment. In recommending prolonged treatment to prevent recurrence, however, the values of each patient need to be considered, along with the age of onset, the meaning of each mood episode, its severity, and the clinical and social circumstances. Several questions remain to be answered. For instance, are there characteristics of first-episode unipolar or bipolar patients that will indicate whether extended treatment will prevent the next episode? How long should treatment be continued, and at what dose? Given the variety of treatments available for mood disorders, are there particular subsets of patients that are better suited or matched for one agent as opposed to another? What are the characteristics of bipolar patients whose depressive episodes can be treated safely with antidepressants, without risk of switching to mania? What are the costs and benefits of extended treatment, not only in terms of side effects and health service utilization, but also in terms of whether the agents we use may actually worsen the subsequent course of illness? Further questions concern the role of psychotherapy in the continuation and maintenance treatment of recurrent mood disorders. Although few clinicians would advocate psychotherapy alone for treatment of unipolar and bipolar patients at high risk for relapse and recurrence, the specific role of psychotherapy remains to be evaluated. It will be important to determine whether structured psychotherapies can provide additional benefit in terms of both episode prevention and functional outcome. This latter issue is particularly important in view of the substantial social and occupational morbidity even in remitted unipolar and bipolar patients--morbidity which is clearly significant in terms of the overall costs of mental illness. Clearly, more work needs to be done. Even the best studies indicate that a substantial proportion of patients are not helped by current treatments.

Adult↗
PubMed1992

Alcohol, head injury, and neuropsychological function.

Evidence is reviewed indicating that the extent of alcohol abuse alone cannot account for the neuropsychological deficits observed in alcoholics, and that alcohol abuse and head injury may interact in some patients to influence neuropsychological status. Alcohol abuse both increases the risk for head trauma and potentiates the resulting brain injury, which can lead to negative neuropsychological consequences. Clinicians involved in the treatment of addiction should assess patients for history of head injury, and neuropsychological deficits consequent to both head injury and ethanol. These deficits may limit patient ability to comply with addiction rehabilitation programs. Conversely, clinicians in acute care and rehabilitation of the sequelae of head trauma should routinely assess their patients for substance abuse, because such abuse can have a significant impact on recovery from brain injury.

Alcoholism↗
PubMed1991

Hepatic hydrothorax. Cause and management.

Significant pleural effusions are infrequently noted in patients with cirrhosis of the liver. A large effusion (hepatic hydrothorax) occasionally appears during the course of the disease. The fluid in the pleural space is believed to be derived from ascitic fluid that may accompany hepatic cirrhosis. Although the exact mechanism is somewhat controversial, it appears that the ascitic fluid is transported directly into the pleural space. A therapeutic thoracentesis, usually accompanied by a paracentesis, may be necessary to relieve acute symptoms. Long-term management, however, centers around eliminating or reducing the formation of ascites. When this is not successful, tube thoracostomy followed by chemical pleurodesis, primary repair of diaphragmatic defects with pleural sclerosis, or peritoneovenous shunting in conjunction with chemical pleurodesis may be attempted. These interventions may or may not be successful. Management of hepatic hydrothorax remains a clinical challenge.

Humans↗
PubMed1990

The potential for mental status changes associated with systemic absorption of anticholinergic ophthalmic medications: concerns in the elderly.

Several cases have been reported of anticholinergic toxicity following the administration of commonly used parasympatholytic cycloplegics and mydriatics. Cases have been reported in children, adults, and the elderly. The risk of developing mental status changes secondary to anticholinergic ophthalmic medications is of particular concern in the elderly. Drug-induced mental status or behavior changes should not be mistaken for exacerbation of an underlying disorder or the onset of a new disease (e.g., Alzheimer's disease, dementia). Clinicians should be aware of these potential complications, monitor for changes in mental status, and take appropriate action.

Absorption↗
PubMed1989

Human adjuvant disease. A new cause of chylous effusions.

Connective-tissue disease occurring after cosmetic surgery with silicone injections or implants has been reported. This disorder has been called human adjuvant disease. One patient is described in whom a chylous effusion and systemic lupus erythematosus-like disorder developed after mammary augmentation with silicone gel-filled prostheses. This patient represents still another example of human adjuvant disease. A brief review of the literature regarding human adjuvant disease is also presented.

Adult↗
PubMed1989

The hamster model of chronic Mycobacterium avium complex infection.

Male golden Syrian hamsters were evaluated as a model for the pathogenesis of human infection with Mycobacterium avium complex. Intratracheal inoculation produced a chronic, nonfatal, pulmonary and disseminated infection (overall rate, 86%). The frequency of infection in hamsters that received 5 x 10(8) versus 1 x 10(8) colony forming units (cfu) was not significantly different (87% and 92%, respectively), but 1 x 10(7) cfu produced infection in only 78% of inoculated animals (P = .034). The percentage of animals developing pulmonary infection with M. avium complex did not differ between inoculum groups (77%-80%). Disseminated infection occurred significantly less frequently in the 1 x 10(7) group (46%) compared with the 5 x 10(8) (79%) and 1 x 10(8) (68%) groups (P = .001 and .056, respectively). After seven weeks, partial clearance of M. avium complex from the lungs coincided with an increased number of animals with splenic involvement. The hamster may be a useful model for human infection with M. avium complex.

Animals↗
PubMed1989

Malignant pleural effusions: pleurodesis using a small-bore percutaneous catheter.

This study describes our experience using a percutaneously placed small-bore catheter for drainage of malignant pleural effusions and subsequent instillation of a sclerosing agent to obliterate the pleural space. We treated 15 consecutive patients with known metastatic cancer and a symptomatic pleural effusion. Twelve patients survived for more than four weeks after the procedure; 11 of these 12 patients had a successful objective clinical response. The procedure was well tolerated, with little or no discomfort during catheter placement and the maintenance period. No serious complications were encountered. We conclude that the use of a small-bore percutaneously placed "pneumothorax" catheter in the management of malignant pleural effusions is an effective and more comfortable alternative to large-bore closed-tube thoracostomy.

Adult↗
PubMed1988

Reading the tuberculin skin test. Who, when, and how?

A prospective study of 806 healthy volunteers was carried out to determine the value of induration 24 hours after placement of purified protein derivative, if patients can accurately read their own tests, and if the pen and palpation methods are comparable. Subjects were actively employed health workers between 20 and 64 years of age without active tuberculosis. All subjects were tested using 5 tuberculin units of purified protein derivative via the Mantoux technique. Induration was quantitated by trained readers at 24 hours and at 48 to 72 hours. Patients were asked to read their own tests as well at 48 to 72 hours. The amount of induration at 24 hours was highly predictive of eventual findings at 48 to 72 hours. The patients' abilities to read their own tests were poor. Significant differences were noted between the pen and palpation methods. The degree of induration noted 24 hours after placement of 5 tuberculin units of purified protein derivative is valuable in a screening population. Most decisions, however, should still be based on results measured at 48 to 72 hours. Results with the pen technique must be interpreted with caution in the 5- to 14-mm range. The patients' readings of their own results are inaccurate and should never be relied on to make clinical decisions.

Adult↗
PubMed1987

Pulmonary disease caused by Mycobacterium malmoense.

Mycobacterium malmoense was isolated from pulmonary material from 4 patients. Two patients had repeatedly positive smears and cultures along with roentgenographic progression of pulmonary disease in the absence of another pathogen. These 2 patients therefore meet the criteria for diagnosis of pulmonary mycobacteriosis. Isolation of the organism may represent colonization in a third patient, and M. malmoense has been isolated from a fourth patient on 2 occasions. It is not yet definite, however, that the pulmonary process is due to mycobacterial disease. Although uncommon, pulmonary disease caused by this organism has been reported from Europe. Only 1 prior case of pulmonary disease caused by M. malmoense, however, has been reported in the United States.

Adult↗
PubMed1985

Comparison of computerized tomography with fiberoptic bronchoscopy in identifying endobronchial abnormalities in patients with known or suspected lung cancer.

Determining the presence and extent of endobronchial involvement is an important part of the evaluation of patients with known or suspected lung cancer. Bronchoscopy is accepted as the best technique for such an evaluation. We have studied the potential usefulness of computerized tomography (CT) for examining the airways by retrospectively comparing CT scans with fiberoptic bronchoscopy findings in 53 patients with known or suspected lung cancer undergoing both tests during the same hospitalization. We have found CT to be moderately accurate in predicting the presence of airway abnormalities (sensitivity from 63 to 85%, specificity form 61 to 77%) but inaccurate in defining the type of abnormality seen at bronchoscopy (localized mucosal abnormality, endobronchial mass, or extrinsic compression). We feel that CT, using standard techniques, should not be relied on for the identification of endobronchial abnormalities in patients with known or suspected lung cancer.

Bronchoscopy↗