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Biomedical subjects

J H Moss

Publications and source records attributed to J H Moss.

9 recordsLinked to original sources
PubMed1998

Iatrogenic benzodiazepine withdrawal delirium in hospitalized older patients.

OBJECTIVE: The purpose of this review was to identify cases of benzodiazepine withdrawal delirium in a population of older hospitalized patients and to determine whether the withdrawal was caused by iatrogenic factors. DESIGN: Retrospective chart review of selected cases from a referred sample. A Bayesian Adverse Reactions Diagnosis Instrument (BARDI) was applied to cases of benzodiazepine withdrawal delirium to quantify the probability that drug withdrawal was the causative mechanism. SETTING: A university-affiliated health sciences center. PATIENTS: A review of the psychiatric consultation liaison service database for a consecutive 4-month period yielded 21 cases of delirium in a referred sample of 119 patients more than 65 years of age. Four cases of benzodiazepine withdrawal were identified within the group of patients with delirium, and retrospective chart review identified potential iatrogenic causes for withdrawal in three patients. RESULTS: The posterior possibilities calculated by the BARDI for the three cases of delirium were 0.98, 0.95, and 0.75, indicating a high probability that the delirium was caused by benzodiazepine withdrawal. CONCLUSIONS: Benzodiazepine withdrawal delirium in older hospitalized patients may be associated with iatrogenic factors.

Aged↗
PubMed1995

Anileridine-induced delirium.

Delirium is a common complication in hospitalized patients and is often associated with significant morbidity. It is important to recognize this syndrome early so that potential causes can be identified and properly managed. Although the etiology of delirium in critically or terminally ill patients is often multifactorial, opioid analgesics are often implicated as a potential underlying cause. Certain opioids, such as meperidine, have been identified as having a greater potential for causing delirium than others. There have been no published reports of anileridine-induced delirium and an illustrative case is presented.

Adult↗
PubMed1994

Respite for caregivers: an evaluation study.

This evaluation study measured the effect of respite on family caregivers of the elderly. The specific aims were: (a) to learn the effect of respite on the evaluation variables of caregiver quality of life, mood, and response to caregiving; (b) to learn relations between the demographic variables and the evaluation variables; and (c) to examine respite to identify benefits other than those being directly measured. Subjects were 130 caregivers, with 6- and 12-month data on a small subsample of the 130. Interviews with caregivers and satisfaction surveys supported respite as an effective intervention. Quantitative analysis showed that none of the evaluation variables changed statistically. The caregiver mood variable evidenced positive changes; other variables changed negatively. Research issues, such as the short time subjects were in the respite program and the lack of sensitive measurement tools, are discussed. Clinical implications for community health nurses are also discussed.

Adult↗
PubMed1990

Evaluating a seminar designed to improve psychiatry skills of family medicine residents.

In an effort to evaluate the effectiveness of a psychiatry seminar designed to teach the principles of psychiatric history taking, diagnosis, and management to first-year family medicine residents, an Objective Structured Clinical Examination (OSCE) and accompanying marking system were designed and used in 1988. The OSCE scores of the family medicine residents who had participated in the psychiatry seminar were significantly higher than the scores of the first-year family medicine residents who had not. The author concludes that this educational format can be effective in teaching psychiatric diagnostic and management skills to first-year family medicine residents, and that further research is necessary to validate the effectiveness of current educational models.

Education, Medical, Graduate↗
PubMed1989

Borderline personality disorder. When medical care is complicated by mental illness.

Management of patients with borderline personality disorder on a medical ward requires the cooperation of all caregivers involved. First, it is necessary to recognize the disorder in patients who exhibit maladaptive behavior. Next, a comprehensive plan of behavioral management should be implemented that includes (1) clear communication among staff members, (2) education of staff members, (3) a consistent approach to the patient, (4) firm limits on the patient's behavior, and (5) an empathic rather than confrontational response to the patient's demands. Use of psychoactive medications may be a valuable adjunct to these approaches. A consulting psychiatrist can confirm the diagnosis and help to develop and implement the management plan.

Adult↗
PubMed1986

Iatrogenic parkinsonism in Huntington's chorea.

This case report describes a 63 year old woman with a nineteen year history of Huntington's Chorea who had been successfully treated with tetrabenazine for 9 years. During a hospital admission for an unrelated medical illness, she was given two doses of chlorpromazine 25 mg for a vascular headache and within hours became mute, extremely rigid, and unable to move or swallow. The consultation psychiatrist confirmed the diagnosis of severe drug-induced parkinsonism by intramuscular injection of benztropine mesylate which resulted in a dramatic immediate improvement. Both chlorpromazine and tetrabenazine were discontinued and the patient's severe parkinsonian symptoms completely abated on oral benztropine mesylate. Tetrabenazine alone, was restarted after 48 hours to control her Huntington's Chorea and there was no recurrence of parkinsonism. (Past history revealed the patient to have tolerated the same doses of chlorpromazine and tetrabenazine when given separately.) Previous literature reports concurrent safe use of antipsychotics with tetrabenazine, but this case report would suggest caution, and early discontinuance in the event of parkinsonism.

Chlorpromazine↗