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Biomedical subjects

M J Tueth

Publications and source records attributed to M J Tueth.

At least 19 recordsLinked to original sources
PubMed2000

Exposing financial exploitation of impaired elderly persons.

There is a dearth of medical publications on financial exploitation of elderly persons, but a significant amount of information on this subject is contained in the literature of other disciplines. Financial abuse accounts for up to one-half of all types of elder abuse in the United States, accounting for over 500,000 victims. Psychological abuse, including deception, intimidation, and threats, always accompanies financial exploitation. Despite the devastating emotional and financial losses incurred, physicians are reluctant to recognize, diagnose, and assist impaired elderly victims of financial exploitation.

Aged↗
PubMed1999

Life-threatening psychiatric emergencies in the elderly: overview.

Behavioral emergencies in the elderly can often be life threatening. Diagnosis and management are problematic, in part due to the high incidence of comorbidity, including medical and neurologic disorders, as well as adverse effects of medications. The behavioral types of life-threatening psychiatric emergencies are confusion, suicidality, homicidality, aggression, and abuse. Substance-induced behavioral changes contribute to morbidity and mortality of elderly patients seen in various settings, including emergency departments, medical floors, and intensive care units. These potentially serious psychiatric disturbances in the elderly are discussed under the subheadings of epidemiology and diagnosis, clinical features and presentations, and management and disposition.

Aged↗
PubMed1998

Special considerations: use of lithium in children, adolescents, and elderly populations.

Certain populations of patients require special considerations when lithium is prescribed. Children and adolescents have higher volumes of body water and more active renal glomerular filtration rates than adults. Their central nervous system is developing and therefore is vulnerable to the impact of substances, including medications such as lithium, that can cause side effects or adverse events. Elderly patients have less body water, slower metabolism, and often comorbid illnesses, so they also require close evaluation and monitoring when prescribed lithium. This paper examines the indications for, pharmacokinetics of, clinical uses of, and side effects of lithium in children, adolescents, and the elderly. Use of alternate mood stabilizers is also addressed briefly.

Abnormalities, Drug-Induced↗
PubMed1997

Managing recurrent nonischemic chest pain in the emergency department.

Many patients who seek emergency evaluation for recurrent chest pain have had negative cardiac evaluations, sometimes including normal coronary angiograms. Despite reassurance, many of these patients return to emergency departments with complaints of chest pain. Studies have shown that one third to one half of these patients suffer from panic disorder characterized by attacks of intense fear accompanied by chest pain or discomfort, nausea, and shortness of breath. If panic disorder is identified, it can be successfully treated. This article explores the causes of recurrent nonischemic chest pain and offers treatment recommendations.

Chest Pain↗
PubMed1997

Misplaced rewards: Veterans' Administration system and symptom magnification.

The process of disability determination in the Veterans' Administration system and the maladaptive patterns of behavior that may develop in veterans attempting to qualify for disability benefits have been subjects of considerable interest to those who care for these individuals. The potential misuse of disability payments by veterans, especially for purposes of financing drug and alcohol dependence, is a related issue of concern. The quest for disability status is frequently an all consuming process, as the veteran attempts to document the presence and severity of his or her disorder to the degree necessary to obtain approval for compensation. Veterans' Administration patients may engage in symptom magnification as a means of convincing healthcare workers of the veracity of their complaints and to establish the necessary paper trail for their disability claims. It is clear when dealing with this challenging patient population that it is exceedingly difficult to know when a patient has a prominent psychologic overlay to his or her condition, is embellishing existing symptoms, or is prevaricating in an effort to obtain disability payments. Although it is essential to focus on the objective signs of disease while attempting to evaluate the subjective correlates, it is also important to determine the motivation of the patient. Rewarding individuals for pain and disability, particularly on a long term basis, can have numerous negative consequences and ultimately may be a disservice to the patient.

Adult↗
PubMed1995

Management of behavioral emergencies.

Accurate diagnosis and a clear management approach are the most important considerations in caring for behaviorally disordered emergency department patients. Treating behavioral emergencies often precedes an accurate diagnosis. A useful approach is differentiating emergencies that need nonpharmacological intervention, minimal pharmacological intervention, or maximal pharmacological intervention. Conditions that require nonpharmacological interventions include suicidal state, homicidal state, self-neglect state, abuse state, and conditions primarily requiring an organic workup. Behavioral emergencies usually requiring minimal pharmacological intervention include adjustment disorder, acute grief, rape and assault, and borderline personality disorder. Behavioral emergencies requiring maximal pharmacological intervention include assault, agitated psychosis, exacerbation of bipolar disorder, exacerbation of schizophrenia, brief reactive psychosis, delirium, dementia, substance withdrawal, and substance intoxication accompanied by violent behavior.

Diagnosis, Differential↗
PubMed1995

The Charles Bonnet syndrome: a type of organic visual hallucinosis.

The Charles Bonnet syndrome consists of visual hallucinations usually described in patients with bilateral eye pathology. The hallucinations are vivid and usually of a pleasant nature. Patients ordinarily maintain insight into the unreal nature of the visions. The syndrome appears to have an ophthalmologic and neurologic disease etiology. Treatment involves correction of the decreased visual acuity.

Aged↗
PubMed1995

How to manage depression and psychosis in Alzheimer's disease.

Depression and psychosis each occur in about 30 to 50% of patients with Alzheimer's disease (AD). Depressive syndromes range from grieving and mild depressive symptoms to major depression. Depression can also mimic the signs and symptoms of AD, a condition known as dementia syndrome of depression. Psychotic syndromes include paranoid delusions, misidentification syndrome, and hallucinations. The diagnosis of both depression and psychosis is based on a careful history and a mental status examination. Treatment includes psychosocial intervention and, when symptoms are severe, drug therapy. The newer antidepressants are recommended for depressive syndromes, whereas psychosis is treated with high-potency neuroleptics.

Aged↗
PubMed1994

Diagnosing psychiatric emergencies in the elderly.

Psychiatric emergencies in the elderly form a small percent of all elderly patients treated in emergency departments. However, accurately diagnosing and understanding behavioral emergencies in the elderly is difficult. Emergency behavioral syndromes in the elderly include confusion, agitation, psychosis, and behavioral regression. Causes of these syndromes in the elderly include delirium, dementia, medication side effects, physical illnesses, depression, and alcohol intoxication/dependency. Emergency physicians should consider each of these diagnostic possibilities when evaluating elderly behavioral emergencies to properly diagnose and treat elderly patients.

Aged↗
PubMed1994

Emergencies caused by side effects of psychiatric medications.

Psychiatric medications cause side effects in several organ systems that need emergency evaluation and treatment. Serious cardiovascular side effects include postural hypotension, cardiac conduction blockade, and SA mode dysfunction; serious neurological side effects include extrapyramidal reactions, seizures, delirium, catatonia, pseudotumor cerebri, ataxia, and glaucoma; serious genitourinary side effects include urinary retention, nephrotic syndrome, and priapism, and the serious hematological side effect of agranulocytosis. Also potentially fatal syndromes secondary to psychiatric drugs are the neuroleptic malignant syndrome, hyperandrenergic crisis, the serotonin syndrome, and lithium toxicity. Individual psychiatric drug classes most notorious for causing side effects with high morbidity and mortality are low potency neuroleptics, clozapine, tertiary tricyclics, monoamine oxidase inhibitors, and lithium.

Agranulocytosis↗
PubMed1993

Clinical uses of pimozide.

One of the more difficult psychopharmacologic aspects of current clinical psychiatry is finding a neuroleptic drug that adequately treats delusional states. Furthermore, many chronic schizophrenics remain resistant to standard antipsychotic medication, and clozapine is effective in only 30% to 50% of refractory cases. In addition, clozapine has several serious side effects and is expensive. We have determined that pimozide is clearly effective in Tourette's syndrome, maintenance schizophrenia, and some delusional disorders. We further demonstrate that the drug is likely to be effective in the treatment of the negative symptoms of schizophrenia and other delusional states. In addition, we suggest that a trial of pimozide may be indicated before giving clozapine to treatment-resistant schizophrenic patients. The side effect that probably most limits pimozide's current use is the possible production of ECG abnormalities. This side effect does not seem to be a realistic clinical concern, however, if the patients are properly screened and the pimozide dose is maintained at or below 20 mg/day.

Clinical Protocols↗
PubMed1993

Anxiety in the older patient: differential diagnosis and treatment.

Anxiety in older patients is more often a symptom of an underlying mental or physical disorder than a primary diagnosis. Its various forms include situational anxiety, adjustment disorder, and phobias. A search for underlying organic causes is important, as age-related diseases, drug side effects, and substance abuse/withdrawal may have etiologic significance. Anxiety may also mask primary psychiatric disorders such as depression or delirium. Therapy requires treating any underlying psychiatric illness and seeking psychosocial intervention for functional causes. If medical therapy is indicated, short-acting benzodiazepines are the first choice, but patients should be followed closely for possible side effects.

Age Factors↗