Biomedical subjects

J Ciarcia

Publications and source records attributed to J Ciarcia.

4 recordsLinked to original sources

PubMed2001

Identification and treatment of depression in a cohort of patients maintained on chronic peritoneal dialysis.

Depression is the most commonly encountered psychological problem in patients with end-stage renal disease (ESRD). Depression has recently been shown to significantly impact on the morbidity and mortality of patients undergoing therapy for ESRD. The present study was designed as a pilot study to evaluate the feasibility of screening a large cohort of patients maintained on chronic peritoneal dialysis (CPD) for depression and then pharmacologically treating those patients assessed to have clinical depression. One hundred thirty-six patients maintained on CPD in our CPD unit were screened for depression using the Beck Depression Inventory (BDI), a self-administered questionnaire. Patients with scores of 11 or greater were referred to a trained psychiatric interviewer for further evaluation to confirm the diagnosis of clinical depression and determine whether the patient was a candidate for antidepressant medication. Sixty-seven patients had BDI scores of 11 or greater, and 60 of these patients were asked to participate in further evaluation and possible therapy. Only 27 patients agreed to further study and were evaluated by a trained psychiatric interviewer for clinical depression. Twenty-three of these patients were assessed to have clinical depression, and 22 patients were eligible for antidepressant medication based on their scores on the Hamilton Depression Scale and psychiatric interview. Eleven patients completed a 12-week course of therapy with antidepressant medication, and their BDI scores decreased from a mean of 17.1 +/- 6.9 (SD) to a mean of 8.6 +/- 3.2. Seven patients were treated with sertraline, 2 patients with bupropion, and 2 patients with nefazodone. It is concluded that (1) depression is commonly present in patients maintained on CPD, (2) the BDI is a useful tool to use to screen for clinical depression, and (3) clinical depression is treatable with medication in this patient population.

Cohort Studies↗

PubMed1987

Effects of bicarbonate-based dental powder, fluoride, and saccharin on dental caries and on Streptococcus sobrinus recoveries in rats.

The effects of NaHCO3-based dental powder containing NaF and sodium saccharin on dental caries and Streptococcus sobrinus recoveries in rats were studied. Weanling specific-pathogen-free Osborne-Mendel (SPFOM) rats were inoculated with S. sobrinus 6715-13WT. One of six infected groups was topically treated with either demineralized water (DW), a dental powder suspended such that there was 1 part solid per 2 parts DW, 0.073% NaF, 0.5% Na-saccharin (Nas), or a combination of NaF and Nas at the same concentrations. NaF-supplemented DW (at 10 ppm F-) was provided to the 6th group of infected rats as a positive treatment control, but this group was otherwise untreated. A seventh but uninfected group was topically treated with DW. All topical treatments were given once for one min daily per rat, for five days per week. Animals' teeth were swabbed for recovery of 6715-13WT and total recoverable flora. At 37 days after start of treatment, S. sobrinus recoveries were lower only for those rats topically treated with the dental powder (p less than 0.05) by comparison with recoveries from the infected, topical DW-treated group. Caries scores, however, were 42% lower for the groups receiving the dental powder (p less than 0.005), 30% lower for those treated with the combined NaF-Nas (p less than 0.005), and 47% lower for the NaF-supplemented drinking water group (p less than 0.005). The dental powder effects, like those for the combined NaF-Nas and NaF drinking water, were evident on both smooth and fissure tooth surfaces. Both the 10 ppm F- drinking water and the dental powder significantly (p less than 0.005) reduced fissure caries scores below the level elicited by the indigenous mutans-free flora in the DW-treated uninfected rats; however, these reduction were not significantly different from one another. Thus, the 10 ppm F- drinking water and the dental powder equally inhibited not only the S. sobrinus-attributable component of caries but probably also the component of caries attributable to the indigenous oral flora.

Administration, Topical↗

PubMed1982

DSM III and consultation-liaison psychiatry: toward a comprehensive medical model of the patient.

The descriptive and multiaxial approaches in DSM III encourage comprehensive conceptualization of the patient. The use of explicit criteria for diagnosing syndromes facilitates communication between psychiatry and general medicine. The DSM III category Psychological Factors Affecting Physical Condition should be further elaborated into (a) Psychiatric Factors Affecting Physical Condition, and (b) Physical Condition Affecting Psychiatric Disorder. In addition, the phase of the illness these factors affect should be specified, i.e., the precipitation, course, and recovery. Somatoform Disorder should not be a diagnosis of exclusion, and the diagnostic criteria should clearly specify that conversion symptoms may be superimposed on a pre-existing physical disorder. The DSM III axes are not coherent: they include diagnostic categories, statements concerning possible relationships, and factors that might affect outcome. We propose an alternative to the DSM III Axes based on the Patient Evaluation Grid (PEG), a system comprised of four axes, including Biological Dimension, Personal Dimension, Environmental Dimension, and Assessment of Interaction Among Dimensions. Developing a comprehensive diagnostic model for both medical and psychiatric patients that can be shared by all physicians may be an important function of the liaison psychiatrist.

Depressive Disorder↗

PubMed1981

Biofeedback and hypertension.

A review of the history and recent directions in the treatment of essential hypertension by direct biofeedback is presented. Current instrumentation and techniques as well as the status of biofeedback in the treatment of hypertension and the follow-up of previous studies is presented. Given the current uncertain status of biofeedback and behavioral treatment of hypertension, the authors present speculation of putative subgroups of essential hypertensives with respective biochemical markers and possible selective behavioral treatments for these respective subgroups of central nervous system hypertensives.

Arousal↗