Biomedical subjects
Publications and source records attributed to M G Wise.
By the year 2030, it is estimated that 17% of the population (52 million people) will be over age 65. Most of these individuals will be taking several medications, and one or more of these medications may be a psychotropic, that is, an antidepressant, anxiolytic, antipsychotic, or lithium. This article summarizes the pharmacokinetic changes that accompany aging and highlight how these changes impact the elderly.
Psychiatric disorders commonly coexist in patients with medical illness. Three disorders encountered frequently are anxiety disorders, depression, and delirium. The authors discuss these psychiatric disorders and their treatment in medically ill patients. Psychiatric consultation may be helpful in such cases.
In medically ill patients, anxiety symptoms and mood alteration are common. Anxiety or mood alteration may be due to a reaction to the stress of illness, a preexisting psychiatric disorder, a manifestation of the medical condition, or an adverse effect of medication. Psychiatrists are frequently called upon to differentiate among these causes and to recommend treatment. This article reviews anxiety, depression, and mania, which are frequently associated with physical disease, and provides an approach to differential diagnosis and treatment.
Two patients who developed choreoathetosis in the course of lithium treatment are described, and other cases of choreoathetosis in lithium-treated patients are reviewed. Choreoathetosis is suggested to be a sign of lithium toxicity, almost always accompanied by other signs of neurotoxicity, such as delirium and cerebellar dysfunction. Of the reported cases, 44% developed permanent movement disorders, and 63% of the patients with permanent deficits were taking both lithium and neuroleptic. When choreoathetosis was not permanent, the average duration was seven days after discontinuation of lithium (range, 1 to 90 days).
A retrospective review of the records of 755 patients seen by a psychiatric consultation-liaison service in a general hospital was performed. The authors found that 87% of manic patients and 38% of depressed patients had a diagnosis of organic mood disorder. The most frequent precipitants of mania were corticosteroids, human immunodeficiency virus (HIV) infection, and temporolimbic epilepsy. The most frequent precipitants of depression were stroke, Parkinson's disease, and HIV infection.
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Lumbar punctures were done on 114 consecutive active duty patients referred for evaluation of positive tests for antibodies to the human immunodeficiency virus (HIV). Eighty-eight percent of these patients appeared to have early HIV infections, as evidenced by intact delayed hypersensitivity, T helper lymphocyte counts greater than 400/mm3, and lack of constitutional symptoms. Forty-four (38.6%) of the patients met our criteria for abnormal cerebrospinal fluid (CSF); another 13 (11.4%) had borderline elevations of nucleated cells or protein and could not be definitely classified as having normal or abnormal CSF. No significant differences existed between the patients with normal and abnormal CSF with regard to age; sex; race; serum FTA-Abs; clinical staging; absolute T helper lymphocyte counts; or cytomegalovirus, Toxoplasma, or Epstein-Barr virus serologies. Seventy-two percent of the patients with abnormal CSF had evidence of possible viral infection of the central nervous system (CNS), as evidenced by increased CSF IgG, increased IgG synthesis rates, or the presence of oligoclonal bands. We found that a significant percentage of asymptomatic patients with apparent early HIV infections have abnormal CSF that is possibly due to CNS involvement by HIV.
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In order to find predictors of success in alcohol treatment, the authors conducted a 1-year follow-up of 71 active duty military personnel treated in a 28-day inpatient program. Success at 1 year follow-up was then compared with variables collected on a patient questionnaire completed at the beginning of rehabilitation. A family history of emotional disorders, together with a single incident precipitating treatment, was associated with a positive alcohol rehabilitation outcome.
The vastly increased use of prescribed and nonprescribed drugs in this society means that even such traditional social work activities as assessment and advocacy now frequently require a knowledge of the effects of drugs. Integrating a knowledge of basic concepts of pharmacology into practice will enable the social worker to help clients more effectively and to improve the health care they receive.
Psychiatric disorders related to acquired immune deficiency syndrome (AIDS) can take various and complex forms. The authors present cases of AIDS patients in whom paranoia, organic brain syndrome, depression, or suicidal ideation was present.
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