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Biomedical subjects

E A Burch

Publications and source records attributed to E A Burch.

At least 19 recordsLinked to original sources
PubMed1995

Rates of sexually transmitted diseases among patients in a psychiatric emergency service.

OBJECTIVE: This study sought to estimate the prevalence of non-HIV sexually transmitted diseases among patients admitted to a psychiatric emergency service and to identify characteristics that might place members of this population at increased risk of acquiring these diseases. METHODS: Hospital medical records and records of public health departments' venereal disease control sections were retrospectively reviewed to determine if patients consecutively admitted to a psychiatric emergency service at a large urban public hospital had been tested for syphilis, gonorrhea, trichomonas, chlamydia, or herpes simplex in the 12 months before admission and whether the tests were positive. Data on patients' demographic and clinical characteristics were also collected. RESULTS: Of 426 consecutive patients studied, 214 (50.2 percent) were tested for one or more non-HIV sexually transmitted diseases. Forty of those patients (18.7 percent) had positive tests. The rates of syphilis and gonorrhea among the patients were significantly higher than those estimated for the city and state where the study was done and significantly higher than the national estimate. Patients whose tests were positive did not differ significantly from those with negative tests in presenting psychiatric symptoms or diagnosis. CONCLUSIONS: An alarmingly high rate of non-HIV sexually transmitted diseases was found among patients treated in a psychiatric emergency service. However, no particular clinical subpopulations at increased risk for acquisition of these diseases could be identified.

Adolescent↗
PubMed1994

Mood congruent and incongruent psychotic depressions: are they the same?

DSM-III and DSM-III-R instruct the clinician, if possible, to classify major depression with psychotic features into either the mood congruent (MC) or mood incongruent (MI) subtype. Patients hospitalized on a psychiatric unit for major depression with psychotic features were classified as predominantly MC or MI. The MC and MI groups did not differ significantly on a number of demographic or symptom severity variables. Thirteen (50%) MI patients experienced at least one MC symptom and 10 (71%) MC patients experienced at least one MI symptom. Overall, 25 (58%) of these patients experienced both MC and MI symptoms. This study demonstrates that subtyping psychotic depression into MC and MI subtypes is seldom an 'either-or' decision. Indeed, these results combined with findings from previous research suggests that there is no compelling scientific evidence for subclassifying psychotic depression into subtypes.

Adult↗
PubMed1994

Suicide attempt histories in alcohol-dependent men: differences in psychological profiles.

Fifty-three alcohol-dependent men without additional Axis I disorders were divided into two groups based on past history of suicide attempts (SP = suicide positive, N = 15; SN = suicide negative, N = 38). Post-hoc analysis revealed that the two groups were matched for age, racial makeup, family history of suicide, and total number of years of drinking. A significantly higher percentage of SP group patients had personal and family histories of either illicit drug use, past psychiatric treatment, or both. Psychological profiles demonstrated exaggerated tendencies toward sociopathy, attitudinal deviance, heightened activity, anxiety, depression, hostility, and disordered thinking among the SP patients. These findings highlight the importance of designing individualized relapse prevention programs.

Adult↗
PubMed1993

Response of psychotic depression subtypes to pharmacotherapy.

Patients with psychotic depression respond well when treated with a combination of an antidepressant and antipsychotic medication. We previously reported that they will respond in a similar fashion when treated with amoxapine monotherapy. There are few prospective studies on the pharmacologic treatment response of psychotic depression subtypes. We treated 37 inpatients, 21 with mood congruent (MC) psychotic depression and 16 with mood incongruent (MI) psychotic depression, in a randomized double-blind fashion with either the combination of amitriptyline and perphenazine or with amoxapine for 4 weeks. Depression and psychosis ratings improved in a similar manner in both the MC or MI patients irrespective of medication treatment group. Global response rates were similar in the MI patients and MC patients. The data suggest that classifying psychotic depression into MC versus MI subtypes may have limited acute prognostic value in pharmacotherapy response rates.

Adult↗
PubMed1992

Methylphenidate hydrochloride as an antidepressant: controversy, case studies, and review.

The use of psychostimulants as antidepressants remains controversial in the field of psychiatry. While methylphenidate hydrochloride (MPH) and dextroamphetamine (DA) are often considered to be equivalent drugs, differences in their neurobiologic mechanism of action may account for different clinical response patterns. Hence, clinical trials and literature reviews that examine the antidepressant efficacy of psychostimulants without distinguishing between MPH and DA may reach inaccurate conclusions. This paper is a critical review of controlled and uncontrolled studies examining the use of MPH as an antidepressant. We discuss the methodologic limitations of existing placebo-controlled trials that have reached mixed conclusions about the efficacy of MPH as an antidepressant. These studies are offset by uncontrolled open trials and clinical case reports that endorse the drug's effectiveness in alleviating depressive symptoms. The series of patients we treated with MPH demonstrates the safety and efficacy of this drug in alleviating depressive symptoms in the medically ill elderly with a variety of mood disorders. Reviewing these six cases and balancing the positive and negative reports in the literature, we provide practical guidelines for identifying patients who are potential candidates for treatment with MPH.

Age Factors↗
PubMed1991

The effects of alcoholism and smoking on platelet eicosanoid production in vitro.

Ethanol induces changes in eicosanoid synthesis in blood platelets and brain tissue. Cigarette smoking also causes alterations in eicosanoid formation. This preliminary report examined in vitro platelet sonicate eicosanoid production using 14C-arachidonic acid (14C-AA) and in separate experiments, 14C-PGH2, as substrates. Radiometric thin layer chromatography (TLC) was used to identify the products formed. Eicosanoid product formation in platelet sonicates collected from 28 abstinent male alcoholics were compared to those from 11 male control subjects. All but one of the alcoholics were chronic smokers and all control subjects were non-smokers. All smokers abstained from smoking for 12 h prior to the blood collection to control for any acute effects of cigarette smoke on eicosanoid production. Significant reductions in platelet sonicate production of PGD2 and PGE2 in vitro were observed in alcoholic smokers when 14C-PGH2, but not 14C-AA, was the substrate. These reductions were predicted equally well by two variables, smoking and alcoholism, using several statistical models. This is the first investigation that controlled for the acute effects of smoking and accounted for the potential effects of cigarette smoking on platelet eicosanoid production in alcoholics. Because cigarette smoking is prevalent among alcoholics, future studies on the role of eicosanoids in alcoholism should control for smoking.

Alcoholism↗
PubMed1990

Amoxapine versus amitriptyline combined with perphenazine in the treatment of psychotic depression.

In a double-blind study lasting for 4 weeks, the authors compared the effectiveness of amoxapine, an antidepressant with potential antipsychotic properties, with a combination of amitriptyline plus perphenazine in the treatment of 38 patients who had the diagnosis of major depression with psychotic features (psychotic or delusional depression). Patients in each group showed similar improvement in depression and psychosis. There was a tendency for the patients treated with amitriptyline plus perphenazine to have higher global response rates. However, the patients given amoxapine had significantly fewer extrapyramidal side effects.

Adult↗
PubMed1990

Variables contributing to distress in male cardiac patients.

Fifty-five male subjects attending a cardiology clinic were examined using a structured interview keyed to a 12-item Hamilton Anxiety Scale (HAS). Sixty-five percent scored in the range of moderate to severe distress with highest mean scores on the following subscales: anxious mood, tension, insomnia, muscular complaints, and global behavioral distress. Two-way analysis of variance revealed the following factors to be significantly associated with higher total HAS scores: greater number of medical diagnoses (P = .007), taking more medications (P = .001), history of psychiatric treatment (P = .007), being declared disabled (P = .002), and living with others (P = .025). Each of these variables might contribute to greater psychological or physical discomfort, increased medical utilization, and difficulty with cardiac rehabilitation. The complexity of psychosocial factors in determining distress is addressed, since subjects living with others scored higher than those who were socially isolated (HAS mean score = 17.9 +/- 8 vs 10.7 +/- 5.5, respectively, P = .025).

Adult↗
PubMed1988

Secondary mania from cerebral embolization with nonfocal neurologic findings.

We have reported a unique example of an organic affective syndrome in a patient who had focal brain lesions, but whose initial neurologic examination was nonfocal. In retrospect, the only clue to an organic disorder was hyperreflexia in this patient with a history of alcohol abuse and clinical signs of a distal sensory neuropathy. This case emphasizes the importance of pursuing a neurologic work-up (including CT scan) in older patients with sudden mood changes, even in the absence of focal neurologic findings.

Adult↗
PubMed1987

Cognitive dysfunction in psychiatric consultation subgroups: use of two screening tests.

Elderly patients are highly vulnerable to illness-related and drug-induced cognitive changes, especially during the acute phase of a medical or surgical illness. Using a structured cognitive screening examination enhances the accurate identification of patients with cognitive impairment. We compared the cognitive portion of the Alzheimer's Disease Assessment Scale (ADAS-COG) to the Mini-Mental State Examination (MMSE) in screening for the presence of organic brain dysfunction. Using cutoff scores, the two tests were in agreement in 94.4% of 36 cases, with total scores on the two tests correlated at r = -.90 (P less than .01). Of these 36 patients for whom psychiatric consultations were requested, 14 (38.8%) were found to be cognitively impaired. We discuss the relationship of test scores to the stated reason for the consultation, as well as variables influencing test results. Finally, we demonstrate the usefulness of cognitive testing in patients who refuse treatment.

Adult↗
PubMed1987

Comparison of two cognitive rating scales in medically ill patients.

Patients with acute, complex behavioral syndromes combined with impaired comprehension and communication are difficult diagnostic challenges. Using a structured mental status interview can significantly reduce the chance of overlooking the presence of cognitive dysfunction. The authors tested the applicability of the cognitive portion of the Alzheimer's Disease Assessment Scale (ADAS-COG) as a screening instrument on a psychiatric consultation service. The ADAS-COG compared favorably with the Mini-Mental State Exam (MMSE), but appeared to be less influenced by educational level. The advantages and disadvantages of using each of these tests on a psychiatric consultation service are discussed.

Adult↗
PubMed1986

Aphasic syndromes and "psychiatric" symptoms: diagnostic dilemmas.

Behavioral syndromes that occur in patients with aphasic disorders without localizing neurologic signs may appear strikingly similar to psychiatric disorders. In the absence of abnormal physical findings, the predominance of psychiatric symptoms, such as avoidance/withdrawal, irritability/hostility, paranoia, or depression, can lead the busy primary care clinician and the unsuspecting psychiatrist away from an organic diagnosis. Through review of selected literature and case presentations, we provide guidelines for evaluating and correctly identifying aphasic disorders masked by complex behavioral syndromes.

Aphasia↗
PubMed1986

Drug intake and the dexamethasone suppression test.

The dexamethasone suppression test (DST) is being used clinically as a diagnostic laboratory test for depression. Drug histories collected from 336 psychiatric inpatients revealed that 60% were taking one or more drugs suspected of altering DST results in either a false-positive or false-negative manner. Practical limitations of the DST as a biologic marker of affective syndromes in relation to patient drug use are discussed.

Depressive Disorder↗