Diagnostic evaluation of elderly patients with mild memory problems.
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Aged↗
Biomedical subjects
Jason E Schillerstrom
Publications and source records attributed to Jason E Schillerstrom.
Executive control function in psychiatric and medical illness.
Executive Control Function (ECF) is the ability to plan, sequence, and monitor one's behavior in order to accomplish a given goal while simultaneously exercising cognitive flexibility to adapt to changing task requirements. Multiple studies demonstrate that ECF predicts functional outcome, level of care required, and work potential for both well and ill populations. However, clinicians often do not routinely assess ECF during mental status evaluations because of the perceived lack of practical bedside tests. This review article discusses the major neuropsychological measures used to probe for impairment, with special emphasis on those that are easily administered at the patient's bedside. The current literature on executive dysfunction in psychiatric and medical illness is reviewed. The neuroanatomy and neurochemistry of ECF is also reviewed, with emphasis on structural dysfunction in specific illnesses. Finally, various treatment options, both pharmacological and psychotherapeutic, are discussed.
Journal Article↗
Modafinil augmentation of mirtazapine in a failure-to-thrive geriatric inpatient.
The failure-to-thrive syndrome in geriatric patients is marked by social withdrawal, apathy, depression, anorexia, and cognitive impairment. For therapy to be effective, the treatment plan must target several of theseareas. This case report describes one such course of treatment for a patient with multiple myeloma with failure-to-thrive who was successfully treated with modafinil and mirtazapine. By using combination pharmacotherapy, we were able to achieve immediate results in a gravely ill patient.
Aged↗
Laboratory findings in emergently medicated psychiatry patients.
OBJECTIVE: To determine routine laboratory differences between patients with severe psychomotor agitation who require emergency intramuscular (IM-medicated patients) medication and those who do not (non-IM-medicated patients). METHOD: A retrospective chart review of patients 18 years or older who went to a psychiatry emergency service over a 30-day period was performed. Demographic and laboratory variables were compared between IM- and non-IM-medicated patients. RESULTS: Emergently medicated patients (n=35) were older than non-IM-medicated patients (n=179) (42.6 vs 34.3 years, P<.001). Patients receiving emergency IM medications had higher leukocyte (WBC) count (P=.04), blood urea nitrogen (P=.001), creatinine (P=.01), glucose (P=.009), aspartate aminotransferase (P<.001), alanine aminotransferase (P=.01), and electrocardiogram QTc interval (P=.03). They were also more likely to have abnormal levels of potassium (P<.05), glucose (P<.05), aspartate aminotransferase (P<.001), and alanine aminotransferase (P<.05). CONCLUSIONS: Emergently medicated patients in this psychiatry emergency service were more likely to be older and more likely to have abnormal laboratories vs other adult patients.
Adolescent↗
Prevalence of executive impairment in patients seen by a psychiatry consultation service.
The prevalence of impairment of executive function among 50 medical inpatients referred for psychiatric consultation was assessed by using the Executive Interview (EXIT25) and an executive clock-drawing task (CLOX). The Mini-Mental Status Examination (MMSE) was also administered to assess general cognition. The percentage of patients who failed each test was calculated. Seventy-two percent failed at least one measure of executive function, whereas only 30% failed the MMSE. The results suggest that impairment of executive function is common among inpatients referred for psychiatric consultation. Because impairment of executive function has been specifically associated with behavioral and functional disability, routine assessment of executive function should be integrated into psychiatric case management.
Adult↗
Prevalence, course, and risk factors for executive impairment in patients hospitalized on a general medicine service.
The purpose of this study was to determine the prevalence, course, and risk factors for executive impairment in patients hospitalized on a general medicine service. One hundred patients were administered the Executive Interview (EXIT25), the Executive Clock Drawing Task (CLOX), and the Mini-Mental State Examination at admission and discharge. Fifty-two percent of the patients at admission and 56% at discharge had scores indicating impairment on at least one measure of executive function. Median scores on every measure improved during hospitalization. Older patients and those with a cardiac or gastrointestinal disorder were more likely to have executive impairment. The prevalence of executive impairment on general medicine services is high. Although improvement in executive function occurs during hospitalization, many patients remained impaired.
Cognition Disorders↗
The impact of medical illness on executive function.
Executive function can be defined as one's ability to plan, initiate, sequence, monitor, and inhibit complex goal-directed behaviors. Although executive impairment is generally associated with dementia, recent studies have suggested that patients with chronic diseases, such as hypertension, chronic obstructive pulmonary disease, and diabetes, may also have executive deficits independent of psychiatric comorbidities. Because executive function is associated with functional outcomes, medication compliance, and the capacity to give informed consent, it is important that it be assessed. However, it is the authors' impression that executive function is not adequately assessed in medical settings, despite the availability of reliable measures. This article reviews the impact of medical illness on executive function and discusses practical diagnostic instruments and treatment strategies. The changes in functional status associated with executive impairment as well as pathophysiology and treatment strategies are also discussed.
Brain↗