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Biomedical subjects

D S Schubert

Publications and source records attributed to D S Schubert.

At least 19 recordsLinked to original sources
PubMed1992

Physical consequences of depression in the stroke patient.

The past literature suggests the hypothesis that depression is associated with decreased physical functional ability in stroke patients. On a medical rehabilitation ward, 21 stroke patients were evaluated for depression by psychiatric interview and self-report, and were also rated on the Barthel's Functional Index (BFI). The hypothesis was supported: Patients scoring 17 or higher on the Beck Depression Inventory (BDI) (N = 7) had lower initial scores on the BFI than patients with lower BDI scores. There was a trend for these seven depressed patients to improve more slowly as ascertained by the BFI. Depression was suggested to lower functional ability by increasing fatigue, hopelessness, and decreasing motivation.

Activities of Daily Living↗
PubMed1992

Decrease of depression during stroke and amputation rehabilitation.

Clinical observation had suggested that mild depression occurs after admission for acute medical treatment and then decreases during further hospitalization for rehabilitation treatment. The Geriatric Depression Scale (GDS) was given on admission and discharge to 14 stroke and 17 amputee rehabilitation patients. Each of the two groups showed decreasing GDS scores from beginning to end of the rehabilitation admission. Suggested reasons included: (1) the gradually diminishing effects of stroke and amputation as life crises during the 1-2 month admission, (2) effects of physical improvement on mood and affect, (3) milieu effects of the medical ward, and (4) tendencies for all psychopathology scale scores to decrease on retest.

Activities of Daily Living↗
PubMed1992

Detection of depression in the stroke patient.

The literature suggests the hypothesis that nonpsychiatrists will underrecognize depression in evaluations of stroke patients. On a medical rehabilitation ward, 15 stroke patients were evaluated for depression by psychiatric interview and self-report. Charts were examined for detection of depression by the rehabilitation team. The hypothesis was supported: in contrast to psychiatric interview (68% depressed) and self-report (Beck Depression Inventory, 50% depressed), none of the patients were described as depressed in chart notes by the rehabilitation team (excluding the psychiatrists). Psychiatrists should develop ongoing interactions with primary care physicians to improve detection of poststroke depression and other depressions on medical wards.

Aged↗
PubMed1992

Increase of medical hospital length of stay by depression in stroke and amputation patients: a pilot study.

Past studies have found that medical patients with the diagnosis of depression (comorbidity) have longer hospital lengths of stay (LOS) than those without the diagnosis of depression. This suggested that scores on a depression scale would be positively correlated with LOS. On a rehabilitation ward, 14 stroke and 17 amputee patients were given the Geriatric Depression Scale (GDS) and lengths of stay were recorded. Correlations between GDS scores and LOS were +0.575 for stroke and +0.266 for amputee patients, both in the hypothesized direction. Explanations considered included: (1) depression and medical illness each produce morbidity which summate to require increased LOS; (2) depression delays medical recovery as well as the appearance of medical recovery, and (3) discharge planning is complicated by depression. When depression is associated with inpatient medical illness, DRGs may need to be reevaluated.

Activities of Daily Living↗
PubMed1991

Delirium after cessation of glucocorticoid therapy.

We report here a case of delirium that occurred after discontinuation of glucocorticoid therapy. Administration of hydrocortisone reversed the mental status changes seen in this patient. We review similar reported cases and discuss the direct actions of glucocorticoids on the brain.

Delirium↗
PubMed1990

The use of the MacAndrew Alcoholism Scale in detecting substance abuse and antisocial personality.

We evaluated the hypothesis that characterological factors, particularly antisocial personality, influence scores on the MacAndrew Alcoholism Scale (MAC). Using the Washington University research criteria to establish diagnoses, the following subgroups were defined: subjects who received no psychiatric diagnoses; subjects who received diagnoses other than alcoholism, drug dependence, or antisocial personality; and subjects who received a diagnosis of alcoholism, drug dependence, and/or antisocial personality, alone or in combination with other psychiatric diagnoses. The highest MAC scores were obtained by subjects diagnosed as having antisocial personality without alcoholism or drug dependence and subjects diagnosed with antisocial personality, drug dependence, and alcoholism. Alcoholics without antisocial personality or drug dependence, and subjects with other psychiatric diagnoses scored lowest. Although higher MAC scores were obtained by males, MAC scores greater than 24 correctly classified the greatest number of males and females as alcoholic, drug dependent and/or antisocial. These findings are interpreted as consistent with MacAndrew's reinterpretation of the scale as assessing a dimension of personality, rather than solely a tendency to addiction.

Adult↗
PubMed1989

Electroencephalographic changes and other indices of neurotoxicity with haloperidol-lithium therapy.

This prospective study was undertaken in order to establish indices of possible neurotoxicity due to the combination of lithium with haloperidol and a combination of lithium with other neuroleptics. Twenty-one subjects who were receiving neuroleptic-lithium combination were studied. Of them, 14 had a primary affective disorder-manic phase, and 7 had schizophrenia as judged by Feighner criteria. The subjects were evaluated on clinical, neuropsychological measures and EEG at baseline and 10-14 days after addition of lithium to the neuroleptic regimen. Of 11 subjects receiving the haloperidol-lithium combination, 5 (45.4%) showed abnormal responses on EEG. Of these 5 subjects, 3 showed abnormal photic responses, and 2 showed slowing in posterior alpha activity. These photoparoxysmal and photomyoclonic responses are indicative of cerebral pathophysiology resulting from the interactive effect of the haloperidol-lithium combination. The photic and other associated EEG abnormalities reported may be the earliest indication of neurotoxicity. No significant changes were observed in the EEG in 10 subjects treated with other neuroleptic-lithium combinations. In a statistical comparison the haloperidol-lithium combination had significantly more frequent EEG changes than the combination of lithium with other neuroleptics. This study presents sufficient evidence from reported photic and other associated EEG changes to pursue further investigation of neurotoxicity due to haloperidol-lithium therapy. Such a study should employ a larger number of subjects, random assignment of subjects to treatment and control groups, and blind evaluation of data.

Adult↗
PubMed1979

A biphasic change in mood with a tricyclic antidepressant.

Eight depressed patients received 150 mg of clomipramine for 4 weeks. They completed the Profile of Mood States five to seven times the first week of treatment and five to seven times at the end of treatment. Moods showing significant decrease from the beginning to the end of the first week were: tension-anxiety, depression, anger-hostility, and confusion. The only changes from the beginning to the end of the 4-week period were an increase in vigor and a decrease in fatigue. The occurrence of rapid and slow mood changes with antidepressants suggested that the former were due to sedative effects and the latter occurred at the rate of the improvement in the disease depression.

Adjustment Disorders↗
PubMed1978

Are divided doses of tricyclic antidepressants necessary?

A double blind control comparison on the effects of 50 mg of clomipramine given three times a day and 150 mg of clomipramine in a single bedtime dosage revealed no significant differences in therapeutic efficacy. Patients reported more lightheadedness and dizziness but no differences on other side effects. The theoretical basis was the long biological half-life of such tricyclic antidepressants. Advantages included ease of administration, patient compliance, and timing of sedative effect.

Adjustment Disorders↗
PubMed1977

Alertness and clear thinking as characteristics of high naturally occurring autonomic nervous system arousal.

Studies of the effect of induced mood on the autonomic nervous system (ANS) suggested that naturally occurring mood might also covary with the ANS. Ss were 13 men and women aged 20 to 70. Fatigue, confusion, and depression were measured on the Profile of Mood States, while barometric pressure and the ANS indices of heart rate and body temperature were also recorded. Fatigue and confusion each showed negative relationships to both heart rate and body temperature. Barometric pressure showed a suggestively positive relationship to the mood of depression. Hypothalamic serotonin concentration was suggested as a central factor producing the covariations between the mood indices (alertness and clear thinking) and the ANS measures.

Adult↗
PubMed1977

Family constellation and creativity: firstborn predominance among classical music composers.

Biographies of classical musci composers were examined for family constellation information. Usable data were found for 80 composers. Firstborns, especially only children, were found significantly more frequently than in a sample of creative writers studied by Bliss. Increased frequency of firstborns was also suggested in a study of musical performers by Raychaudhuri. Classical musci composition was seen as an ability more similar to usual academic pursuits than creative writing.

Birth Order↗
PubMed1977

Teaching psychiatry to medical students on a consultation service.

Medical students experience psychiatric consultation as part of their undergraduate psychiatric clerkship experience. This allows further identification of the medical student with the psychiatrist in management of psychiatric problems in patient who are primarily non-psychiatric. Reaction has tended to be favourable from the medical students without a great loss of speed or efficiency in terms of the service committment.

Education, Medical, Undergraduate↗
PubMed1976

Psychiatric consultation education--1976.

The teaching of consultation liaison (CL) psychiatry to psychiatric residents, medical students, and other trainees is reported from 92 medical schools, representing 81% of those surveyed with a one-page questionnaire. Psychiatric residency programs devote approximately 10% of their time to CL training, a slight increase over the percentage ten years ago. Approximately 35% of medical students in programs from which we received responses have some consultation CL education, although this varies from a few seminars to an eight-week full-time rotation. Other trainees receiving CL experience include nonpsychiatric residents and interns (22 programs), psychologists (18), nurses (12), and social workers (5). Program directors report an approximately 90% "favorable" reaction to such training by all trainees. Consultation liaison training for residents still represents a small portion of their entire experience. A surprisingly large percentage of medical students are exposed to CL education, but with tremendous variation in that exposure. Other trainees are not heavily involved in CL programs, indicating a possible future expansion of integrated psychosomatic teaching. The data presented should serve as a comparative baseline for future program design.

Allied Health Personnel↗