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J Tonkonogy

Publications and source records attributed to J Tonkonogy.

6 recordsLinked to original sources
PubMed1992

Privilege and discharge decisions for psychiatric inpatients with dysphagia.

Psychiatric patients have an increased risk for choking compared with the general population because of risk factors such as medication side effects and food gorging. A state hospital program for managing patients with dysphagia, or difficulty swallowing, includes interventions such as modified diets, mealtime monitoring, and adjusting psychotropic medications. Clinicians may find it difficult to make decisions about privileges and placement for dysphagic patients who do not comply with dietary modifications in unsupervised settings. For many such patients, close supervision and even placement on a locked ward may seem necessary. The authors recommend a risk-benefit approach: clinicians must balance the safety afforded by restrictions against the benefits of increased privileges or placement in a less restrictive setting. Quality of life and patients' preferences must also be considered.

Activities of Daily Living↗
PubMed1991

Dysphagia in psychiatric patients: clinical and videofluoroscopic study.

Deaths due to airway obstruction are more common in psychiatric inpatients than in the normal population. A dysphagia program was started in a 400 bed Massachusetts psychiatric hospital after 4 patients in 1 year died from asphyxia. In the year after the program was started, there were no deaths; however, 28 patients experienced 32 choking incidents. The 28 patients received clinical evaluations by speech pathologists, neurologists, psychiatrists, and internists. Of the incidents, 55% required use of the Heimlich maneuver to open the airway. Choking incidents could be classified into five types based on results of clinical examination: bradykinetic, dyskinetic, fast eating syndrome, paralytic, and medical. Twenty-one of the 28 patients were studied by videofluoroscopy and 86% of the videos were abnormal, showing aspiration in eight, webs in five, and delay in the oral phase in five. Patients with bradykinetic dysphagia (secondary to neuroleptic-induced extra-pyramidal syndrome [EPS]) and paralytic dysphagia appeared to experience a more severe form of choking.

Adult↗
PubMed1981

Language function, foot of the third frontal gyrus, and rolandic operculum.

Two cases with expressive speech disorders were studied neuropsychologically and neurologically; anatomical and histopathological examinations were performed in both cases. In case 1, a small infarction in the foot of the left third frontal gyrus (F3) produced only transient word-finding difficulties that did not recur after a second stroke with lesion of the symmetrical zone in the right hemisphere. A transient, predominantly articulatory difficulty was observed in case 2; this was thought to be associated with a small infarction in the lower motor strip, including the Rolandic operculum. On the basis of the literature and our two cases, it may be concluded that overlapping lesions of these two areas play an important role in the development of persistent Broca's aphasia and that each of these two areas may be responsible for different components of the speech production: work-finding difficulties being associated with lesions of posterior F3 and articulatory disorders with lesions of the Rolandic operculum.

Aphasia, Broca↗
PubMedDate not supplied

Alois Alzheimer on presenile dementia.

The work of Alois Alzheimer on presenile dementia is a landmark in the history of psychiatry not fully appreciated by contemporary psychiatrists. In this paper, the history of his landmark work is reviewed in the context of the growing importance of psychiatric involvement in Alzheimer's disease. Annotated excerpts from Alzheimer's second paper (1911), never before translated into English, are presented. The historical significance of Alzheimer's findings vis-a-vis Kraepelinian psychiatry and the relationship of his investigations to modern psychiatric research in primary degenerative dementia of the Alzheimer type are discussed.

Alzheimer Disease↗