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Biomedical subjects

K J Weiss

Publications and source records attributed to K J Weiss.

At least 19 recordsLinked to original sources
PubMed1999

Waiving death row appeals: whose right is it anyway?

Death row prisoners may elect to forgo appeals, thus hastening execution. There are many reasons for such a decision, including depression, psychosis, incompetence, conditions in prison, and others. Due to the gravity of the sentence, and the states' duty to ensure fairness, some jurisdictions impose restrictions on the waiver. An inmate who lacks trial competence may be subject to a habeas corpus hearing and the appointment of a "next friend," often a family member. Moreover, the Constitution forbids execution of the "insane." The decision, then, may be taken out of the inmate's hands. The author outlines the various tests for competence to waive appeals. The Pennsylvania case of Gary Heidnik (In re Heidnik, 112 F.3d 105 (3rd Cir. 1997); and In re Heidnik, 720 A.2d 1016 (Pa. 1998)) illustrates the issues surrounding waiver of appeals that concern psychiatrists, attorneys, and judges. Following a discussion of Heidnik and related cases, the author offers a proposal for a classification of types of inmates requesting waiver.

Capital Punishment↗
PubMed1999

Psychiatric testimony and the "reasonable person" standard.

The aim of this article is to explore the boundaries of psychiatric testimony in criminal cases. In a series of vignettes, the author describes applications of psychiatric testimony in nontraditional areas. These are criminal cases in which the defendant-who was not mentally ill-acted in response to a situation that would tend to trigger violence in many persons: protection of self or others. In scenarios involving self-defense, duress, and passion/provocation, the dynamics involve interpersonal situations that give rise to behavior that may be entirely foreign to the defendant but that could not have been avoided. The law looks at these matters through a "reasonable person" standard: what the ordinary citizen would have done. In principle, there is often no need for expert testimony, because judges and jurors are presumed able to assess reasonableness, justification, or provocation. The trier of fact, however, could use a psychiatric explanation to assess culpability. The author discusses the cases in terms of application and admissibility.

Adult↗
PubMed1998

Anxiety, depression, and diseases of the lower extremities.

There are many physical disorders that have little or no organic basis. Many of these conditions are caused by mental pathology. Certain emotional disorders can magnify the person's ability to perceive pain. Anxiety and depression are often the culprits. It behooves the podiatrist to be aware that anxiety and depression can be a cause of foot and ankle pain or that they can exacerbate true physical symptoms. The podiatrist should be able to perform a rudimentary psychological evaluation in the outpatient clinical setting, and should be prepared to make a timely and proper referral to a mental health professional for additional testing and treatment.

Adult↗
PubMed1996

Optimal management of anxiety in older patients.

Although the incidence of anxiety disorders diminishes with age, the prevalence of anxiety symptoms among older patients is substantial. These symptoms, which include cognitive and somatic manifestations, are a source of diminished quality of life. The many potential sources of illness- and medication-induced anxiety must be excluded before instituting treatment. The general principles of antianxiety medication treatment in older patients include: (i) symptom relief with minimum sedation; (ii) improvement in sleep; (iii) freedom from autonomic and cognitive toxicities; and (iv) freedom from physical dependence and drug interactions. Older compounds such as the tricyclic antidepressants should be avoided, since more modern agents (e.g. benzodiazepines and buspirone) are well tolerated and effective. Modern antidepressants have also been used to reduce anxiety symptoms, although there is a potential for the opposite effect to occur. The selective serotonin reuptake inhibitors appear to be better suited to treating syndromes such as panic and obsessive-compulsive disorder, whereas nefazodone would be a better choice for generalised anxiety complicated by depression.

Age Factors↗
PubMed1994

Management of anxiety and depression syndromes in the elderly.

Elderly patients are susceptible to disruptions in mood from a variety of sources: primary anxiety or mood disorders, medical illnesses and treatments, and psychosocial stressors. The goals of intervention are to discover reversible etiologies, treat in the least intrusive manner, and improve or restore quality of life. The clinical presentation may vary from typical anxiety or depression, to mixed symptoms, to a highly somatized or dementia-like picture. The most common disturbance is mixed anxiety/depression. Once the threshold is reached for drug therapy, there are safe and effective remedies, including azapirones, short-acting benzodiazepines, serotonin reuptake inhibitors, and others. Because elderly patients are more vulnerable to drug side effects such as sedation and orthostatic hypotension, selection of the therapeutic agent is crucial. Management strategies, therefore, tend to avoid sedating agents and those with strong autonomic effects. Antipsychotic drugs, unless specifically indicated--for example, in cases of delusional depression--are to be avoided in simple anxiety/depression syndromes. Prescribers for patients in nursing facilities must also observe Omnibus Budget Reconciliation Act (OBRA) regulations. These include preference for psychosocial over drug therapies, avoidance of physical and chemical restraint, and minimal use of any psychotropic medication.

Age Factors↗
PubMed1994

Confronting anxiety and depression in primary care.

Primary care physicians treat many patients with anxiety and depression. These disorders have excellent treatment responses, but can be overlooked due to varied presentations. Physician education concerning anxiety and depression is important.

Anxiety Disorders↗
PubMed1991

Prescribing under OBRA. Myth and reality.

The Omnibus Budget Reconciliation Act (OBRA) aims to reduce unnecessary psychotropic drugs in nursing facilities, bringing prescribing practices under scrutiny. Yet, OBRA can be adapted by physicians.

Drug Prescriptions↗
PubMed1989

Treating anxiety in primary care.

Anxiety disorders are a group of highly treatable problems seen in primary care. Physicians wishing to treat panic and generalized anxiety must know differential diagnoses, medications, and patient education strategies.

Anxiety Disorders↗
PubMed1986

Pharmacotherapy of psychiatric emergencies.

The psychiatric emergency service has become a major provider of psychiatric care over the past decade. Concomitant with this growth has been an emphasis on pharmacological treatment. While rapid tranquilization is the best known and most frequently used intervention, a growing diagnostic awareness has led to a variety of other chemotherapeutic approaches. The current reviews of pharmacologic intervention in the psychiatric emergency service do not detail the variability of treatment approaches or examine alternative treatment approaches. The goal of this article is to critically review current pharmacologic treatments and address areas in which there is no consensus in treatment approach. From this review the authors suggest guidelines for pharmacotherapy of psychiatric emergencies. The authors discuss rapid tranquilization, the treatment of alcohol and drug intoxication and withdrawal, and anxiety disorders.

Amphetamines↗
PubMed1986

Prescription drug abuse.

Prescription drug abuse (PDA) accounts for much drug-related morbidity and mortality. The PDA issue contains several interrelated dimensions: regulatory, practical, and clinical. Historical and current governmental efforts to regulate prescribing practices are reviewed. The authors discuss the many ways that prescription drugs can be diverted for abuse purposes and how potential abuse situations can be identified in the clinical setting. Types of prescribers at risk for promoting PDA are discussed and remedies for PDA are offered in terms of physician and patient education.

Aged↗
PubMed1986

Rapid tranquilization: a comparison of thiothixene with loxapine.

This 6-day study evaluated the efficacy of equivalent doses of loxapine and thiothixene for rapid tranquilization of acutely disturbed, psychotic patients. After initial tranquilization with intramuscular injections for 24 hours, 58 patients were treated for 5 days with oral medication. With both drugs, intramuscular treatment demonstrated clinically significant improvement from baseline on Clinical Global Impressions and Brief Psychiatric Rating scales; this improvement continued during the oral phase. Median time to tranquilization was significantly less with loxapine (60 minutes) than with thiothixene (95 minutes); during the oral phase, there were no significant differences between the two treatment groups. Side effects were minimal during the intramuscular phase; dystonia was most common during the oral phase.

Administration, Oral↗
PubMed1985

Rapid tranquilization: the efficacy of oral concentrate.

The efficacy of oral concentrate in the rapid tranquilization of 159 acutely disturbed patients in a psychiatric emergency service was evaluated. Patients were randomly assigned to 1 of 10 treatment groups: 7 oral groups and 3 comparison intramuscular groups. Although intramuscular medication produced a faster response, concentrate also proved to be effective for rapid tranquilization. Side effects were benign and minimal. Age, sex, race, and diagnosis had no effect on outcome. The use of concentrate as a paradigm for treating acutely psychotic patients is discussed.

Acute Disease↗