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Biomedical subjects

J H Eastham

Publications and source records attributed to J H Eastham.

12 recordsLinked to original sources
PubMed2001

Postpartum alopecia.

OBJECTIVE: To determine whether there are effective treatments for postpartum alopecia. DATA SOURCES: Clinical literature identified through MEDLINE (January 1966-May 2000), EMBASE (June 1980-March 2000), and International Pharmaceutical Abstracts (January 1970-March 2000). Key search terms included alopecia, puerperium, and postpartum. DATA SYNTHESIS: Postpartum alopecia is a diffuse shedding of scalp hair that can begin two to five months following parturition. Few articles examine the treatment of this condition. Treatments in the form of thyroid supplementation, topical progesterone and estradiol lotions, and an oral contraceptive have been studied. All available studies on this subject have significant limitations, such as small sample size, absence of a control group, or subjective measurement of treatment response. Nondrug therapy for a related type of hair loss has been recommended and includes education about hair cycles and reassurance to minimize anxiety. CONCLUSIONS: From the available studies, no specific treatment has been studied well enough with sufficient treatment justify recommendation or to be termed effective.

Adult↗
PubMed1998

Correlates of functional status in older patients with schizophrenia.

There is a growing recognition of the importance of quantifying the impact of illness on functional abilities. Measures of function frequently rely on a self-report. Few studies have directly assessed functional capacity in psychiatric patients, especially older ones who may be at an increased risk for disability. Subjects were 102 middle-aged and elderly outpatients with DSM-III-R or DSM-IV diagnosis of schizophrenia or schizoaffective disorder, and 66 normal comparison subjects, ranging in age from 45 to 86. The Direct Assessment of Functional Status (DAFS), a standardized measure of behavior during simulated daily activity tasks (i.e. time orientation, communication, transportation, finance, shopping, grooming and eating) was used to quantify levels of disability. Schizophrenic patients demonstrated significantly greater disability than normal subjects. An evaluation of specific behaviors indicated that the patients were significantly more limited than comparison subjects across all subscales of the DAFS except for grooming and eating. A lower level of formal education, greater severity of extrapyramidal symptoms, and greater cognitive deficits, but not severity of symptoms of schizophrenia, were related to lower DAFS scores. Relative to published findings, schizophrenic patients appeared more disabled than outpatients with major depression, but less disabled than those with Alzheimer's disease. The DAFS is a useful instrument for characterizing functional abilities in older patients with schizophrenia. Our findings of significant functional disability in older schizophrenic patients have implications for treatment as well as allocation of health-care resources.

Activities of Daily Living↗
PubMed1998

Assessment and treatment of bipolar disorder in the elderly.

The aetiology of late-onset bipolar disorder is heterogeneous because the disease is more likely to have a secondary (i.e. a medical disorder or medication-induced) cause in older than in younger patients. Elderly patients with bipolar disorder typically require lithium dosages that are 25 to 50% lower than those used in younger individuals. Information on the use of valproic acid (sodium valproate) in elderly patients with bipolar disorder is limited but encouraging. In contrast, there is virtually no information regarding the use of carbamazepine or other drugs in this patient group. Electroconvulsive therapy is well tolerated by older people and can be useful for these patients.

Aged↗
PubMed1997

Treatment of schizophrenia and delusional disorder in the elderly.

With increasing longevity, greater numbers of patients with schizophrenia and delusional disorder will be surviving into advanced age. Antipsychotics form the core of the treatment for both of these psychotic disorders. Treatment of elderly patients with antipsychotics is, however, complicated by a much higher risk of adverse effects such as tardive dyskinesia. More is known about treating patients with schizophrenia than those with delusional disorder. The introduction of newer atypical antipsychotics may herald a new era in the pharmacotherapy of elderly psychotic patients. Nonetheless, judicious dosing is essential in the geriatric population. We discuss the benefits and limitations of the main forms of treatment.

Aged↗
PubMed1996

Reversal of erythema multiforme major with cyclophosphamide and prednisone.

OBJECTIVE: To report a case of erythema multiforme (EM) major treated with cyclophosphamide and prednisone. SETTING: General medicine and dermatology consult services, Department of Veterans Affairs Medical Center. CASE SUMMARY: A 44-year-old man with C4-C5 quadriplegia developed a skin reaction characterized by a painful, generalized maculopapular rash, bullae, ulceronecrotic lesions, and mucosal and epidermal sloughing after taking trimethoprim/sulfamethoxazole. The patient was treated with intravenous cyclophosphamide 150 mg infused over 1 hour every 24 hours and oral prednisone 15 mg every 6 hours. After two doses of cyclophosphamide, formation of bullae and epidermal sloughing had ceased, and the erythema was markedly diminished. Cyclophosphamide was discontinued before the third dose because of evolving leukopenia. Prednisone therapy was continued until the patient was discharged on hospital day 5, at which time the dosage was tapered. DISCUSSION: Cyclophosphamide has been used extensively for other dermatologic reactions. Relief of pain and regression of the lesions in our patient occurred more quickly than anticipated. CONCLUSIONS: Treatment of EM major with cyclophosphamide combined with prednisone appeared to be highly successful in this patient. Cyclophosphamide may be an effective, empiric initial treatment in reversing EM major.

Adult↗
PubMed1996

Management of late-life psychosis.

Since the average lifespan is becoming longer, the number of older patients with psychoses is expected to increase. Late-life schizophrenia is prototypical of these chronic psychotic disorders. Antipsychotic drugs are the most effective symptomatic treatment. Pharmacotherapy in older patients, however, is complicated by alterations in pharmacokinetics and pharmacodynamics. The risk of many adverse effects is considerably higher in the elderly. For example, we found the cumulative annual incidence of tardive dyskinesia among patients over age 45 to be 26%, which was five to six times greater than that reported in younger patients. Studies suggest that most patients with schizophrenia relapse without neuroleptic maintenance therapy, exemplifying the need for improved pharmacologic regimens. Data concerning the use of the newer serotonin-dopamine antagonists in patients with late-life psychoses are limited. Initial studies suggested that clozapine is efficacious, but its use is limited by side effects. Risperidone is also clinically beneficial and is generally well tolerated, but needs to be prescribed in lower doses than those recommended for younger adults. Antipsychotic use in the elderly should be accompanied by careful conservative dosing and close patient monitoring.

Adult↗
PubMedDate not supplied

Adverse neurobiological effects of long-term use of neuroleptics: human and animal studies.

Neuroleptics have revolutionized the treatment of schizophrenia and other psychoses since the early 1950s. Several adverse neurobiological effects are, however, associated with the long-term use of these agents. This article will review human and animal studies of these adverse effects, and also present some new data. Tardive dyskinesia (TD) is the most widely studied potentially persistent movement disorder resulting from long-term neuroleptic treatment, and several risk factors for TD development have been identified. Although drug-induced parkinsonism (DIP) usually disappears after the offending agent is withdrawn, a small portion of patients may have persistent parkinsonism. It is however, unclear if this is an aging-related effect. Persistent cognitive impairment associated with long-term use of typical neuroleptics has not been well documented. Atypical antipsychotics may produce improvement in cognitive performance in patients with chronic schizophrenia. MRI changes that are secondary to neuroleptics are possible, but have not yet been studied adequately. There is one unconfirmed report of neurofibrillary tangles associated with long-term neuroleptic use. A number of investigators have reported vacuous chewing movements, and neuropathologic changes following prolonged administration of neuroleptics in animals. We discuss the implications of the various reported adverse effects of long-term use of neuroleptics.

Aged↗
PubMedDate not supplied

Fish oil as an adjuvant in the treatment of hypertension.

STUDY OBJECTIVE: To evaluate the effects of omega-3 fatty acids on blood pressure control and lipid levels. DESIGN: Double-blind, placebo-controlled, randomized study. SETTING: Veterans Affairs Medical Center teaching hospital. PATIENTS: Twenty-one men whose blood pressure was not optimally controlled with antihypertensive agents, who met the inclusion criteria. INTERVENTIONS: Patients were randomized to receive either fish oil (4.5 g omega-3 fatty acids/day) or placebo. MEASUREMENTS AND MAIN RESULTS: Blood pressure readings were taken at baseline, and 4 and 8 weeks. Sitting systolic and diastolic blood pressures were significantly reduced in the fish oil group at both week 4 (148/97 to 132/90, p <0.05) and week 8 (148/97 to 134/91, p <0.05). Sitting diastolic blood pressure was significantly reduced in the placebo group at week 8 (94 to 88, p <0.05). There was no difference in percentage change of sitting systolic and diastolic pressures at week 8 comparing the placebo group (-6.4% and -6.3%, respectively) and the fish oil group (-8.8% and -6.6%, respectively). Triglyceride levels (-40.9%, p <0.05) and platelet counts (-8.7%, p <0.05) were significantly reduced at 4 weeks, and low-density lipoprotein (LDL) cholesterol levels were significantly increased both at 4 and 8 weeks (13.5% and 19.1%, respectively) in the fish oil group. CONCLUSION: Adjunctive fish oil supplementation did not substantially augment blood pressure lowering in treated hypertensive men with suboptimally controlled blood pressure. Effects on plasma lipid values were mixed, with an increase in LDL cholesterol and a decrease in plasma triglyceride levels.

Adolescent↗
PubMedDate not supplied

Ethnicity and movement disorders.

This article is a review of studies involving ethnicity and spontaneous as well as iatrogenic movement disorder. We have focused on Parkinson's disease and tardive dyskinesia. Some early studies reported that African Americans had lower rates of Parkinson's disease than Caucasians, whereas more recent surveys have not found such a difference. Several studies suggested that African Americans have a higher risk of developing tardive dyskinesia than Caucasians, even when differences in neuroleptic drug use are accounted for. Asians seem to have a lower or equal risk of developing tardive dyskinesis as compared with Caucasians. We discuss the possible contribution of ethnicity to the etiology of movement disorders and the implications thereof.

Adolescent↗