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Biomedical subjects

M J Dewan

Publications and source records attributed to M J Dewan.

At least 19 recordsLinked to original sources
PubMed2003

Pharmacological strategies in treatment-resistant depression.

Treatment-resistant depression may be due to factors such as co-morbid psychiatric or medical illnesses, chronic psychosocial stresses, and medication nonadherence. Alternative treatment strategies such as optimization, switching to a different antidepressant, augmentation or combination with another antidepressant are strategies useful in such patients. The first strategy in treating resistant depression is to optimize monotherapy. A switch should be made to another agent if there is no response to treatment after an adequate duration. Augmentation and combination strategies are useful if there is sub-optimal response to the initial antidepressant. With several antidepressants (selective serotonin reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors and the newer antidepresssants) and various antidepressant augmentation and combination strategies available to clinicians, the outcome of treating patients with depression should improve.

Antidepressive Agents, Tricyclic↗
PubMed2003

Psychopathology in sickle cell disease.

Acute and chronic medical conditions are often complicated by psychiatric symptoms. Depression and anxiety are two of the most common psychiatric symptoms that complicate the diagnosis and management of medical conditions. Despite the well-known association between chronic medical conditions and psychiatric diagnoses, psychopathology among individuals with Sickle cell disease (SCD) is not well recognised. The purpose of this article is to examine the relationship between psychiatric symptoms and SCD. We reviewed the existing literature regarding the psychological sequelae among patients with SCD. We then recommend how to better identify and treat psychopathology associated with this condition.

Anemia, Sickle Cell↗
PubMed2001

Psychiatric complications of malaria: a case report.

This article reviews the psychiatric complications of malaria. A case of malaria infection is described. The diagnoses, treatment, and neuropsychiatric complications of acute and chronic malaria infection are discussed. The treatment of malaria and its complications are summarized.

Acute Disease↗
PubMed1999

Evaluating the tolerability of the newer antidepressants.

Given their equal efficacy, the choice of a specific antidepressant is largely influenced by side effect (SE) profiles. A number of new agents have recently become available. However, data directly comparing the side effects of these agents are scarce. As suggested by AHCPR guidelines, we used the 1998 Physicians' Desk Reference (PDR) to construct a comparison table using treatment emergent, placebo-adjusted incidence rates for the major (gastrointestinal, central nervous system, and sexual) side effects caused by nine antidepressants (fluoxetine, paroxetine, sertraline, fluvoxamine, nefazodone, bupropion SR, mirtazapine, venlafaxine XR, and citalopram). The results were tabulated to show the relative propensity of each drug to cause a particular side effect. Bupropion SR had the most favorable overall side-effect profile, and fluvoxamine the least favorable. However, there are several limitations in using the PDR to compare the newer antidepressants. Clinical studies directly comparing SEs of newer antidepressants are needed. Sexual SEs substantially affected total SE liability. A simplified summary table, with its advantages and some limitations, is not simple to construct. Pitfalls in this process are discussed.

Antidepressive Agents↗
PubMed1995

The clinical impact of reported variance in potency of antipsychotic agents.

There is significant disagreement on the clinical equivalence (or potency) of antipsychotic agents, with up to 500% variance reported in texts. To address the extent and consequences of these discrepancies, we took a random sample of 18 common psychiatry, psychopharmacology and pharmacology texts for antipsychotic equivalence tables. We found a marked variation in stated equivalences for the majority of antipsychotics. Most affected were the high potency (haloperidol, fluphenazine) and newer (molindone) drugs, which had a 500% variance. This variation inadvertently contributes to the misuse of these agents. For instance, high-potency antipsychotics are prescribed in far larger doses than necessary, leading to decreased efficacy and increased side effects. Steps to simplify and rationalize the use of these agents are recommended.

Antipsychotic Agents↗
PubMed1995

The physician and unconventional medicine.

BACKGROUND: Unconventional medical therapies, that is, health interventions not normally taught in medical school, consume more than $10 billion per year; yet, little is known of physician involvement with these therapies. METHOD: A national mailed survey of primary care internists with single board certification and of board-certified family physicians was undertaken to determine physician attitude and behavior toward unconventional therapies. The survey identified 16 unconventional therapies. RESULTS: A total of 572 responses were analyzed. These indicated that more than half of these physicians would encourage patients who raise the possibility of unconventional therapy. A large proportion (57%) were willing to refer their patients for treatment for six or more unconventional therapies. CONCLUSIONS: This study indicates considerable physician interest and participation in unconventional medicine, suggesting a need for research and education to help them guide their patients.

Adult↗
PubMed1993

Antidepressant side effects and physician prescribing patterns.

We studied the following questions: (1) Do physicians preferentially prescribe antidepressants (ADs) with the least side effects (SEs) of sedation, orthostatic hypotension, and anticholinergic activity; (2) Have there been any recent changes in prescribing patterns; and (3) Do patterns differ for psychiatrists and nonpsychiatrists. Data on psychiatrist and non-psychiatrist outpatient prescribing of specific ADs were obtained from the National Prescription Audit (NPA) for 1986 and 1989. In 1986, physicians did not minimize the use of ADs with the most of these SEs. The 1989 data indicate that psychiatrists made a major change toward prescribing more low SE ADs and less ADs with the most SEs. The data for nonpsychiatrists also suggest some movement in this direction. The availability of fluoxetine and the concomitant focus on SEs may have contributed to this shift. Further investigation is needed to clarify factors that influence physicians' choices of ADs.

Antidepressive Agents↗
PubMed1992

Adding medications to ongoing psychotherapy: indications and pitfalls.

Research suggests that psychotherapy and psychopharmacology together have benefits beyond those when either is used alone. However, since many patients benefit from psychotherapy alone, medications are not always necessary. Medications should be added when patients are unable to deal with their problems in psychotherapy and their symptoms become troublesome. Drastic clinical deterioration, or increased anxiety or acting out that disrupts ongoing psychotherapy, are other indications. Patients' transference color their attitude towards prescribing, or not prescribing, medications and should be dealt with openly. Some patients equate their being given medications with caring, nurturance, or validation of their suffering. Others see it as an imposition of external controls, or a comment on their psychological weakness. Not being given medications benefits patients who think that the therapist "must be interested in me and not just in my symptoms" or that "I can do it myself." Angry, dependent patients may perceive it as withholding of support, prolongation of agony, not being taken seriously, or not being seen as sick enough. Therapists' countertransference may dictate the addition of medications as a distancing or even punishing maneuver. When prescribing, clinicians should choose specific agents with the least side effects, foster "psychopharmacotherapeutic alliances" to enhance compliance, and educate patients regarding common and serious--but not all possible--side effects to decrease complaints. Psychotherapy requires substantial skill to perform competently; psychotherapy and medication requires even greater sensitivity and does not mean that only half the usual attention can be paid to each modality.

Combined Modality Therapy↗
PubMed1992

Comparison of three depression rating scales.

We directly compared scores on the self-rated Beck Depression Inventory with two other common rating scales that assess a wider range of psychopathology, including depression, the self-rated Symptom Check List-90--R (SCL-90--R), and the clinician-rated Brief Psychiatric Rating Scale for 71 inpatients who suffered from depression (n = 50) and other disorders. All measures of depression showed robust correlations among themselves. The self-rated scales correlated better between themselves than with the clinician-rated scale. Since the SCL-90--R assesses depression as well as the Beck inventories, is also a self-report instrument, yet provides a richer description of psychopathology with little extra effort, it may have some advantage over the latter.

Adult↗
PubMed1992

Factitious disorders with psychological symptoms.

BACKGROUND: Factitious disorders with psychological symptoms have been underdiagnosed and hence undertreated. Historically, the literature has focused on factitious disorder with physical symptoms, particularly Munchausen's syndrome. METHOD: The authors report three cases of factitious disorder with psychological symptoms that had diverse clinical presentations. RESULTS: Two of the patients had features of a psychiatric Munchausen's syndrome--being middle-aged, aggressive men who falsified their symptoms, treatments, and backgrounds. The third patient was a younger woman with comorbid substance abuse, dysthymia, and borderline personality disorder. CONCLUSION: The authors feel that there is a need for refinement of diagnostic criteria, greater awareness, and evaluation of treatment approaches for this condition.

Adult↗
PubMed1988

Bipolar affective disorder. I. Comprehensive quantitative computed tomography.

Based on clinical similarities with schizophrenics and previous computed tomography (CT) studies that found distinct structural abnormalities in the brains of bipolar patients, we evaluated 26 DSM-III bipolar patients and 22 controls by CT, using quantitative measures of ventricular and sulcal size and of cerebral parenchymal density. Third ventricle size was increased, as was periventricular and cortical density. Comparison is made with results found in other psychotic conditions and the possible etiopathological significance discussed.

Adult↗
PubMed1988

Bipolar affective disorder. II. EEG, neuropsychological, and clinical correlates of CT abnormality.

Since the clinical significance of CT abnormalities found in bipolar patients remains obscure, we studied 26 DSM-III bipolar patients who had specific CT abnormalities (third ventricle enlargement, and hyperdensity of the caudate, thalamus, anterior frontal white matter, and right temporal lobe) on numerous parameters such as EEG, the Halstead-Reitan Neuropsychological Battery, premorbid personality adjustment, family history of affective disorder, positive and negative symptoms, employment history, and response to lithium carbonate treatment. None of these measures could differentiate between the CT abnormal and CT normal subgroups. The implications of these findings are discussed.

Adult↗
PubMed1987

Normal cerebral asymmetry in bipolar patients.

Reversal of normal cerebral asymmetry has been reported to be more frequent in children with higher cortical dysfunction and in schizophrenics, in whom it has clinical significance as well. As there are few studies of bipolar patients, we attempted to determine if significant reversal would be found in a clearly diagnosed sample of bipolar patients. As technical differences may account for varying results, we used two previously reported methods and a modified technique. Correlations of computed tomography (CT) findings with neuropsychological variables (Halstead Reitan Battery and WAIS subtests) were also studied. Bipolars and controls did not differ on any CT measure, nor were there meaningful correlations between asymmetry and neuropsychological variables. If if is confirmed that schizophrenics have increased reversed cerebral asymmetry but bipolars do not, it may point to an important difference, as all other CT abnormalities initially described in schizophrenics are now also noted in bipolar patients.

Adult↗
PubMed1986

Relative utility of three indices of neuropsychological impairment in a young, chronic schizophrenic population.

The complete Halstead-Reitan Neuropsychological Test Battery and the Wechsler Adult Intelligence Scale were administered to 20 young, male, chronic schizophrenics. Three commonly used indices of neuropsychological impairment were calculated and compared. Although all three indices were similar in separating computerized axial tomography normal from abnormal patients, statistical significance was achieved only with the Halstead Impairment Index. Thus, the easier-to-obtain Halstead Impairment Index appears to be at least as good as, and possibly better than, the more-difficult-to-obtain indices of Percent of Ratings within the Impaired Range and the Average Impairment Rating. Reasons for these findings are discussed.

Adult↗