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Biomedical subjects

Kenneth R Kaufman

Publications and source records attributed to Kenneth R Kaufman.

16 recordsLinked to original sources

Complicated hypertension related to the abuse of ephedrine and caffeine alkaloids.

Ephedra containing products (ECPs), which most often contain additional sources of caffeine alkaloids, may be an under-recognized cause of hypertension. ECPs, especially when used in combination or at higher than recommended doses, can cause life-threatening cardiovascular and neurological complications. We present a case of hypertensive encephalopathy with new onset generalized tonic-clonic seizure secondary to concomitant use of two OTC supplements containing a mixture of ephedrine and caffeine alkaloids.

Adolescent↗

Ziprasidone-induced priapism requiring surgical treatment.

Both typical and atypical antipsychotic psychotropics have been reported to cause ischemic priapism presumptively secondary to alpha1-adrenergic blockade. This condition is a urologic emergency for if not evaluated and treated appropriately, long-term sequelae include erectile dysfunction and impotence. This paper addresses the first reported case of priapism requiring surgical intervention presumed to be secondary to ziprasidone. Increased clinician and patient education regarding priapism is required in order to minimize this adverse event and to maximize immediate treatment.

Adult↗

Childhood mourning: prospective case analysis of multiple losses.

Multiple losses within short time periods make one question life and can exponentially influence one's coping skills. But what are the effects on a child and what should be done when the next loss occurs? This case addresses the multiple losses suffered by a child while assessing coping skills of the child and coping strategies used by the parents to assist the child.

Adaptation, Psychological↗

Monotherapy treatment of paruresis with gabapentin.

Paruresis, the difficulty or inability to urinate in the presence of others, is a highly prevalent (7-32%) social anxiety subtype that is both chronic and pervasive. Paruresis negatively impacts quality of life. Treatment strategies have focused on psychological interventions. To date, standard social anxiety pharmacotherapies utilized in the treatment of paruresis have shown minimal efficacy. A PUBMED search revealed no references to paruresis treatment with selective serotonin reuptake inhibitors or gabapentin. This case report presents the first instance of successful monotherapy treatment of paruresis with gabapentin. The patient's relative medicine noncompliance resulted in an on-off-on treatment design with a dose-dependent response. Efficacy persisted throughout a 7-month treatment course. Gabapentin should be studied further for its potential use in the treatment of paruresis.

Amines↗

Etanercept, anticytokines and mania.

Cytokines influence multiple psychiatric and medical conditions. Proinflammatory cytokines are associated with depression. The novel treatment of autoimmune diseases with anticytokines presents a unique strategy to understand the role of cytokines in affective disorders. Specifically, because antidepressants can be associated with cycling into manic states, and antidepressants can be associated with resolution of cytokine-induced depression, then, hypothetically, the treatment of a vulnerable patient who has an affective disorder with an anticytokine could also result in cycling. The development of a manic episode is described in a patient with psoriatic arthritis who was treated with etanercept, a tumour necrosis factor-alpha antagonist.

Adult↗

Pseudoseizures and hysterical stridor.

Differentiation of pseudoseizures from epileptic seizures and hysterical stridor from asthma is key to the treatment of patients. Both pseudoseizures and hysterical stridor are associated commonly with sexual abuse, eating disorders, depression, substance abuse, anxiety disorders, and personality disorders. Failure to reach an appropriate diagnosis results in inappropriate medical care including recurrent intubations, antiepileptic drugs, and excessive hospitalizations. This case represents the first instance of reported pseudoseizures in a patient with hysterical stridor secondary to childhood sexual abuse.

Academic Medical Centers↗

Monotherapy treatment of bipolar disorder with levetiracetam.

Bipolar patients with early-onset, comorbid substance abuse, rapid cycling, and mixed episodes are difficult to treat and frequently require rational polypharmacy. When polypharmacy is unsuccessful, the clinician must consider the off-label use of newer psychotropics. Levetiracetam is a novel anticonvulsant with antikindling, inhibitory, and neuroprotective properties that is effective in an animal model of mania. This case report describes a patient with treatment-resistant rapid cycling bipolar disorder who failed 15 psychotropics, individually or in various combinations (maximum of 6), but ultimately responded to levetiracetam monotherapy and remained without bipolar features during 1 year of maintenance treatment, excluding 1 week during which the patient was medicine noncompliant. Further, methylphenidate used to treat comorbid attention deficit disorder did not precipitate manic features. Levetiracetam should be further studied for its potential use in the treatment of bipolar disorders.

Adult↗

Adjunctive oxcarbazepine in comorbid anxiety and affective disorder with hyponatremic seizure: case analysis and literature review.

Rational polypharmacy is required for management of refractory psychiatric disorders. Antiepileptic drugs are increasingly used as primary or adjunctive agents in the treatment of affective, schizoaffective, anxiety, and impulse control disorders. In this case report, the authors present the first case of hyponatremic seizure associated with oxcarbazepine in adjunctive treatment of comorbid affective/anxiety disorders.

Adult↗

Caffeinated beverages and decreased seizure control.

Seizure control is often affected by seizure threshold lowering behaviours. In this case report, the authors address excessive caffeine ingestion from tea with increased seizure frequency. When decaffeinated beverages were substituted for the tea, seizure frequency returned to baseline. Similar findings occurred when the patient was re-challenged. The authors recommend avoidance of excessive caffeine in patients with epilepsy.

Beverages↗

The ups and downs of bipolar disorder.

This brief historical overview of bipolar disorder addresses diagnosis, treatment, cost, creativity, suicide, and stigma with a review of the literature. This served as the introduction to the 27th Annual Scientific Meeting of the American Academy of Clinical Psychiatrists (51 references).

Bipolar Disorder↗

Comparative bioethics in bipolar and epilepsy research.

RATIONALE: AEDs are increasingly evaluated for efficacy in bipolar disorders utilizing double-blind, placebo-controlled, randomized clinical trials (RCTs) as required by the FDA. However, the risk to patients is under-estimated in trial design. Bipolar depression has a significant risk for suicide; bipolar episodes can lead to kindling with increased long-term morbidity; rapid regression may occur during the placebo phase or during dose ranging trials with resultant active suicide status. The associated risks mandate that the ethics of FDA-required protocols are addressed. METHOD: Comparative analysis and literature review of bipolar and epilepsy research designs. RESULTS: In psychiatry, all INDs require RCTs for approval. In epilepsy, AEDs are initially approved as add-on agents only. Once AEDs have demonstrated add-on efficacy, cross-over studies comparing active AEDs, sub-optimal dosing paradigms, new-onset, and pre-surgical inpatient placebo trials are utilized to prove efficacy of the new AED in monotherapy. Ethical considerations to avoid seizures and to minimize risks to subjects have led to newer clinical trial designs. CONCLUSIONS: The FDA initially requires add-on studies with new AEDs due to the risk of seizures during the placebo phase. The author argues that bipolar research warrants similar add-on studies to prove efficacy because the risk of suicide and increased long-term morbidity in the bipolar population is as significant as the risk of seizures in the epilepsy population. Although the number of patients needed to prove statistical efficacy would increase, the safety of such research would also markedly increase. The author further concludes that with the risk of suicide during bipolar research, ethical considerations require increased frequency of patient contact with a significant other co-signing the informed consent for research and serving as a contact for the coordinator.

Anticonvulsants↗

Epilepsy neurosurgery: a patient's perspective.

Contemplation of epilepsy neurosurgery for a patient with lifetime epilepsy poses difficult decisions and can be quite fearful. As epileptologists, we often do not appreciate the degree of patients' concerns, especially whether quality of life could be worsened by surgical complications. In this poem, a patient lyrically describes this dilemma.

Epilepsy↗

And then the dog died.

Childhood grief and mourning of family and friends may have immediate and long-lasting consequences including depression, anxiety, social withdrawal, behavioral disturbances, and school underachievement. Childhood pet bereavement is no less important, because the pet is often considered a member of the family by the child. However, society does not always acknowledge the significance of pet bereavement, which can result in unresolved grief. This article, a case analysis with literature review, addresses childhood pet bereavement in the context of multiple prior losses (K. R. Kaufman & N. D. Kaufman, 2005). This case mirrors both old and new findings in grief research and therapy: (a) beneficial response to emotional expression of grief in context of search for meaning; (b) beneficial response to cognitive approach toward grief with ability to prevent development of complicated grief even in the face of multiple losses; (c) beneficial effects associated with supportive family and with positive self-concept; (d) intensity of grief magnified by the child's degree of attachment to the pet, the suddenness of the pet's death, the multiple prior losses, and the role of the pet in the child's life; and (e) resiliency. This case further emphasizes the need for parents not to trivialize death of pets, to appreciate the role pets have in children's lives, and to assist the child in multiple approaches toward expression (be it verbal, written, or artistic). Finally, this case reinforces the ability of the child to assist in family bereavement and to serve as teacher.

Adaptation, Psychological↗

Neuroleptic malignant syndrome and serotonin syndrome in the critical care setting: case analysis.

BACKGROUND: Serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) are medical emergencies associated with psychotropic administration. Differentiation and treatment can be complex, especially when features of both syndromes are present and the patient has taken both serotonergic and neuroleptic agents. METHOD: Case analysis of a poly-drug overdose (venlafaxine, topiramate, divalproex sodium, risperidone, and carbamazepine) presenting with mixed SS/NMS features and whose clinical management suggests a practical algorithm for treatment of undifferentiated SS/NMS in critical care settings. RESULTS: The suggested algorithm includes: 1) Supportive care and withdrawal of all potentially offending agents; 2) Laboratory evaluation with prompt initiation of treatment for both disorders--cyproheptadine for SS and dantrolene for NMS; 3) Do not use bromocriptine (contraindicated in SS) or chlorpromazine (contraindicated in NMS) initially; 4) Add bromocriptine when clinical presentation becomes consistent with NMS (SS can be prolonged if serotonergic agent has long half-life). CONCLUSIONS: Prompt and appropriate identification and intervention are essential for successful management of SS and NMS. The suggested treatment algorithm allows for specific treatment of both disorders and avoids potentially exacerbating either one. The algorithm derived from this case could serve as both a practical guideline and impetus for further investigation in light of increasing psychotropic co-administration.

Adult↗