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Biomedical subjects

M E Swigar

Publications and source records attributed to M E Swigar.

10 recordsLinked to original sources
PubMed1992

A retrospective study on the perceived need for and actual use of psychiatric consultations in older medical patients.

OBJECTIVE: The authors examined the (under) utilization of the psychiatric consultation service for patients aged sixty to seventy-five who were hospitalized for medical reasons, and explored whether one could retrospectively document and identify a greater need for psychological support than the one reflected in the number of actual consultations requested. Three questions were addressed: 1) the psychiatric consultation rate; 2) the frequency of unrecognized medical, psychiatric, and psychosocial complicating factors; and 3) whether the distribution of these factors differed by gender. METHOD: Records of 203 consecutively-admitted elderly patients hospitalized on medical wards were reviewed by two experienced general hospital psychiatrists for any indication of medical, psychiatric, and psychosocial risk factors. The frequency of actual psychiatric consultations was also recorded. RESULTS: Three or more risk factors were noted in the records of 36 percent of all patients. Consultation was sought for only 3 percent. Gender differences in type and distribution of risk factors were identified. CONCLUSIONS: Indicators and profiles that define probable need for psychiatric consultation were identified and briefly discussed. More well-designed, prospective studies testing these indicators and profiles are needed.

Aged↗
PubMed1991

Single and repeated admissions to a mental health center: demographic, clinical and use of service characteristics.

Eight hundred and forty one patients with 1,135 consecutive admissions to a university-affiliated mental health center were studied to examine patterns of treatment program use. Twenty two percent of patients had repeat admissions accounting for 42% of hospital episodes. Single admission and repeater groups are compared, and differences among repeater subgroups with progressively greater numbers of admissions per patient are described. Only 10 patients with the highest number of admissions during the study period also were very high utilizers of all services (inpatient, crisis, day hospital, regional chronic state hospital). These patients' characteristics are discussed with implications for future study.

Adolescent↗
PubMed1990

"Superwarfarin" ingestion. A new problem in covert anticoagulant overdose.

For the attention of psychiatric consultants, brodifacoum, a new longer-acting, warfarin-like oral anticoagulant rodenticide, has been used for suicide attempts. The overdose potential with brodifacoum is serious since it is readily available without prescription, and bleeding complications last for weeks to months after a single ingestion. This article reports a case of ingestion and reviews four similar cases from medical literature. Also reviewed are details about mechanism of action, procedures for diagnosis, and treatment requirements. Also, characteristics of persons who ingest long-acting anticoagulants appear to differ from those who ingest short-acting anticoagulants reported from earlier literature.

4-Hydroxycoumarins↗
PubMed1979

Thyroid function screening in psychiatric patients.

Abnormalities in levels of total thyroxine and thyroxine binding capacity were common in a group of 480 newly admitted psychiatric patients. The estimated free thyroxine (EFT4) level was elevated in 43 patients (9%). In 27 of these patients, the level of EFT4 became spontaneously normal, usually within a two-week period (acute "stress hyperthyroidism"). The level of EFT4 was decreased in 42 patients (9%). In 16 of these patients, the level became spontaneously normal; the etiology of this apparent acute hypolhyroidism is unclear. The yield of new cases of primary hyperthyroidism and hypothyroidism was low, but a presumptive diagnosis of secondary hypothyroidism was made in eight patients. In addition, nine patients with known thyroid disease were taking inadequate or excessive replacement therapy. Thyroid function screening tests are of value in psychiatric patients.

Adolescent↗
PubMed1979

Plasma cortisol levels in depression and other psychiatric disorders: a study of newly admitted psychiatric patients.

Morning and evening plasma cortisol levels were checked in 123 consecutively newly admitted psychiatric patients with a variety of diagnoses. Questions asked were whether there were differences among groups with more severe illness, type of depression, alcohol abuse, or particular symptoms. Morning cortisol elevation was found in 33% of patients and was not associated with any particular diagnostic category. Evening cortisol elevation occurred in 85% of the subjects. It was significantly higher in those with unipolar depression and organic brain syndrome, also in those patients who abused alcohol regardless of diagnosis. Evening cortisol elevation was twice as common in patients with diagnoses of more severe psychiatric illness than in those with minor disorders. Further study is suggested to see if these patterns of cortisol elevation are sustained beyond the stress-of-admission period.

Adjustment Disorders↗
PubMed1977

Thyroid function in depression and alcohol abuse: a retrospective study.

Admission thyroid function tests were reviewed in 115 euthyroid patients with depression (66), depression and alcohol abuse (30), or alcohol abuse (19). Estimated free thyroxine (EFT) levels ranged from 0.7 to 2.7 ng/100 ml (normal, 1.0 to 2.1). Levels above 2.1 ng/100 ml were associated with agitation and values under 1.1 with alcohol abuse. Mean EFT levels differed significantly among six diagnostic subgroups and paralleled rank order for severity of depression (none, secondary, reactive, single uncategorized, recurrent, psychotic). Alcohol abuse negatively affected EFT: there was a significant decrease of mean EFT level from nonabusers to abusers and, further, to intoxicated abusers. A positive association between EFT level and severity of depression, and a negative one with alcohol use, were significant when other variables considered were controlled. These two factors accounted from 28.2% of variability in EFT levels, with a minimal additional contribution of medication effect.

Adjustment Disorders↗
PubMed1977

Abortion applicants: characteristics distinguishing dropouts remaining pregnant and those having abortion.

This study, of two groups of women who applied for induced hospital abortion, compares 100 women who had the abortion with 100 women who dropped out to carry to term. Dropout applicants who elected to carry to term had less education, had partners with less education, tended to be indecisive, and when they told their partners tended to receive negative responses toward abortion. In addition, these women expressed greater concern about the procedure and about the moral implications of abortion. Implications of this study for further research on women's and their partners' decision-making about abortion using the Janis-Mann model are discussed.

Abortion Applicants↗
PubMed1976

Depression and normal pressure hydrocephalus. A dilemma in neuropsychiatric differential diagnosis.

Normal pressure hydrocephalus (NPH) is a surgically correctable syndrome of progressive dementia, gait abnormalities, and urinary incontinence resulting from an occult hydrocephalus in association with normal cerebrospinal fluid pressure. Occurring most frequently in midlife and often idiopathic in origin, the early course of the illness may be characterized by symptoms of apathy, inattentiveness, agitation, and poverty of thought which mimic a depressive illness and may delay the recognition and treatment of the underlying structural defect. A review of the literature reveals that this association of depressive symptomatology and NPH has received little attention in the psychiatric literature, and the authors describe a case of NPH which presented as a severe, agitated depression. Clinical findings which suggest the presence of NPH are discussed, and the need to include NPH in the differential diagnosis of depression in the presenium is emphasized. The authors believe such diagnostic vigilance is necessary if the needless deterioration of potentially salvageable individuals is to be prevented.

Age Factors↗