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Biomedical subjects

M F Weiner

Publications and source records attributed to M F Weiner.

At least 19 recordsLinked to original sources
PubMed1992

Group therapy reduces medical and psychiatric hospitalization.

This article studies the impact of outpatient group therapy on medical care at a large city-county hospital. Of the 65 group therapy outpatients, 33 persons met the criterion of having attended at least 12 group sessions over the course of a year. We compared a control period (the year prior to initiating group therapy) with a study period (months 6-18 after starting group) and found a sharp decrease in the number of hospitalizations and in-hospital days. There was significantly increased use of neuroleptics and nonpsychotropics and increased attendance at nonpsychiatric clinics.

Adult↗
PubMed1991

Advances in clinical research in Alzheimer's disease.

There has been an explosion of clinical research on Alzheimer's disease (AD) in recent years, shedding light on many aspects of the disease. These include the differentiation of AD from normal aging, appreciation of genetic aspects of the disease, characterization of its pathology and pathophysiology, and the beginnings of a rational approach to treatment. Alzheimer's disease (AD) is a clinicopathologic diagnosis. In the near future, it may be possible to confirm the clinical diagnosis by examination of spinal fluid or by skin biopsy, but the diagnosis of AD in 1991 is based on history, direct examination of the patient and, ultimately, confirmation by microscopic examination of the brain. In short, we stand very close to where Dr. Alzheimer stood when he reported a hitherto unrecognized form of dementing illness in a 51-year-old woman. Alzheimer's case was cited by the editor of the journal in which it was published as an example of the need to look closely at patients from both clinical and pathologic perspectives so that individual diseases might eventually be separated out from syndromes such as dementia. Since Alzheimer's report, many clinical studies have shed further light on this disease. Two important deterrents to Alzheimer's disease research were the presumption that dementia is either a normal age-related phenomenon or a psychotic disorder of old age. The assumption that dementia is a product of normal aging or a functional psychotic disorder of late life was first challenged by Corsellis, who found a strong correlation between the severity of cerebral degenerative change and clinical diagnosis of patients who died in a psychiatric hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

Alzheimer Disease↗
PubMed1991

Experiences with depression in a dementia clinic.

Of 317 consecutive cases seen in a dementia clinic, 19 (6%) had little or no objective evidence of cognitive impairment on clinical examination and extensive neuropsychological testing. Of the remaining 298 cases, 192 (64%) were diagnosed as probable or possible Alzheimer's disease (AD). Of the 19 nondemented cases, 8 (42%) were thought to have cognitive difficulty due to depression. In the AD group, only 4 cases (2%) were thought to be depressed and only 2 of the 4 met DSM-III-R criteria for major depression. There was no relationship between Hamilton Rating Scale for Depression scores and either cognitive or behavioral measurements of dementia severity, suggesting that the difference between the two groups was not due to underreporting by AD patients. The authors concluded that a tertiary care setting, depression is a common cause of cognitive complaints in persons without organic disease and a rare cause of excess morbidity in AD.

Adult↗
PubMed1990

Single photon tomography in Alzheimer's disease and the dementias.

Measurements of brain blood flow has evolved over the past 50 years, and during the latter half of that time radionuclide techniques have been used to study this important function. Using Xenon 133 and scintillation multiprobe systems, several teams of investigators measured regional cerebral blood flow (rCBF), and noted that under many circumstances it could be equated with local brain physiological activity. The dementias were investigated using the scintillation multiprobe method, and posterior flow deficits were described in patients who were thought to have Alzheimer's disease. The multiprobe technique gave way first to planar, and then tomographic imaging, with initial favorable results achieved by positron emission tomography (PET). Soon investigators learned to measure rCBF with single-photon emission computed tomography (SPECT) using high-sensitivity systems and 133Xe as a tracer, or high-resolution systems with 123I-iodoamphetamine (IMP), and later, 99mTc-HMPAO. Three-dimensional tomographic imaging shows to advantage the flow patterns that characterize Alzheimer's disease, with rCBF reductions in temporal, parietal, and sometimes frontal areas, as opposed to randomly distributed deficits in multiinfarct dementia, reduced frontal flow in entities such as Pick's disease, and others. Herein we will review our own experience with high-sensitivity rCBF SPECT in 119 patients with dementia, and with high-resolution SPECT, using a new, three-camera scanner and 99mTc-HMPAO in an additional 39 patients. SPECT rCBF study of patients with dementia and Alzheimer's disease, will aid in separating patients with untreatable Alzheimer's from those patients who may have treatable causes of dementia, and will be useful in evaluating experimental drugs for the treatment of Alzheimer's disease.

Alzheimer Disease↗
PubMed1990

Older psychiatrists and their psychotherapy practice.

Interviews with 15 elderly practicing psychiatrists found them cheerful, optimistic and enjoying doing psychotherapy. Most practiced as they had been trained originally, saw outpatients primarily--though fewer and less frequently--than they had earlier in their careers. They experienced fewer transference and countertransference difficulties; and were neither more advice-giving nor self-disclosing than earlier in their careers. All had suffered numerous traumatic events, including ill health and death of spouses, but managed to keep that information out of the therapeutic relationship. Their primary professional concern was maintaining their practices; their major personal concern was the possibility of disability.

Aged↗
PubMed1989

Age and cortisol suppression by dexamethasone in normal subjects.

A study of 60 healthy volunteers ranging from 19-88 yr of age found nonsuppression rare (5%) and confirmed that the dexamethasone suppression test (DST) of the reactivity of the hypophyseal-pituitary-adrenal axis to negative feedback inhibition requires 0800 h plasma dexamethasone (DEX) levels in excess of 220 ng/dl. All of the subjects with inadequate DEX levels (N = 3) were older than 50 yr of age as were the nonsuppressors (N = 3); two of the three nonsuppressors had inadequate DEX concentrations. Thus, DST may be more often invalid in elders than in younger adults because of inadequate plasma dexamethasone (DEX) concentration, indicating that plasma DEX levels should be assayed concomitantly with DST in elders.

Adult↗
PubMed1989

A very modest proposal for 1990s C/L psychiatry.

The prediction that consultation-liaison psychiatry would play an integral role in the management of all medical/surgical patients in large hospitals has not come to pass. The primary reason is that no adequate funding mechanism has ever been found to support such a large endeavor. The economic climate as we enter the 1990s makes such funding even less likely. The authors suggest that C/L psychiatry accept a lesser role, largely confined to teaching hospitals. That role, which has been successful at a large public teaching hospital for nearly 10 years, encompasses serving as a primary psychiatric teaching site for medical students, a primary teaching site for psychiatry residents and other postgraduate physicians rotating through psychiatry, a source of innovative dispositions for medically ill psychiatric patients, and a source of opportunity for interdisciplinary research.

Education, Medical↗
PubMed1989

The effect of acetazolamide on regional cerebral blood flow in patients with Alzheimer's disease or stroke as measured by single-photon emission computed tomography.

Regional cerebral blood flow (rCBF) was assessed in 35 patients with possible or probable Alzheimer's disease (AD) and in 16 patients known to have had at least one stroke. Patients were evaluated before and after the administration of 1 g acetazolamide (ACZ) by means of a rotating four-detector single-photon emission computed tomograph (SPECT) and inhaled Xe-133. RCBF values in mL/minute/100 g were derived from eight cortical regions of interest (ROI), and from the whole transverse section as a measure of whole brain flow (WBF). ROI/WBF ratios were calculated for each ROI in paired determinations done before and 15 minutes after the administration of ACZ. Results were compared with those previously obtained in a study of 15 normal, healthy volunteer subjects. ROI/WBF ratios greater than 2 standard deviations (SD) below the mean for a given ROI in the normal group were regarded as probably abnormal, whereas ratios greater than 4 SD below the mean were considered definitely abnormal. After ACZ administration, the number of ROI greater than 2 SD below the normal mean decreased significantly in the AD group and was unchanged in the stroke patients. However, the number of ROI/WBF ratios greater than 4 SD below the normal mean fell in the AD group and rose in the stroke group, with the difference in behavior highly statistically significant. Thus, the response of low-flow areas to ACZ differs in AD and in stroke, which could be of ultimate diagnostic significance.

Acetazolamide↗
PubMed1987

Influence of age and relative weight on cortisol suppression in normal subjects.

The authors examined the effects of certain nonpsychiatric variables on dexamethasone suppression test (DST) results. Sixty physically healthy, nondepressed, nondemented adults participated in a standard outpatient 1-mg DST. Postdexamethasone plasma cortisol concentrations were higher in older subjects and were lower in more obese subjects. The authors conclude that age and relative weight influence cortisol suppression in healthy subjects.

Adult↗