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Biomedical subjects

M K Popkin

Publications and source records attributed to M K Popkin.

At least 73 records · Page 4Linked to original sources
PubMed1981

Effects of caffeine withdrawal on isoproterenol-stimulated cyclic adenosine monophosphate.

The effect of short-term caffeine withdrawal on lymphocyte beta-adrenoceptor sensitivity was studied in seven men who had been drinking coffee daily for at least 3 mo before the study. The ratio of cyclic adenosine monophosphate production after in vitro incubation with isoproterenol and a blank was used to assess receptor sensitivity. There was a reduction in sensitivity to isoproterenol but not to prostaglandin E1 3 days after caffeine withdrawal. The mechanism of this effect is not clear, but may represent a biochemical correlate of caffeine-withdrawal syndrome.

Adrenal Medulla↗
PubMed1981

Consultation-liaison outcome evaluation system, Part I. Teaching, applications.

Designed to assess clinical outcomes quantitatively, the Consultation-Liaison Outcome Evaluation System, Part I, includes methodologies to measure the frequency of and concordance with recommendations made by psychiatric consultants in three areas: recommendations for psychotropic medication, recommendations for diagnostic action, and representation of psychiatric diagnoses. Using these parameters, the performance of three psychiatric trainees was monitored for a 6-month period. The outcome obtained by the trainees were compared with normative rates achieved by a group of previous psychiatric consultants. The comparison provides a unique perspective on the trainees' progress with several teaching implications. First, it focuses clinical teaching on comprehensive and objective measures to trainee's performance, Second, it assists in curriculum design. Third, it emphasizes to trainees the necessity of altering one's clinical behavior based on results achieved. Finally, it suggest that clinical accountability can contribute to the teaching of clinical excellence.

Curriculum↗
PubMed1981

Unrecognized physical illness prompting psychiatric admission: a prospective study.

The authors studied 100 state hospital psychiatric patients consecutively admitted to a research ward who were screened to eliminate physical illness before admission. They found an unusually high incidence of medical illness: 46% of these patients had an unrecognized medical illness that either caused or exacerbated their psychiatric illness, 80% had physical illnesses requiring treatment, and 4% had precancerous conditions or illnesses. A workup consisting of psychiatric and physical examination, SMA-34, urinalysis, ECG, and EEG after sleep deprivation identified over 90% of medical illnesses present in this population. The authors suggest that such a battery be part of the routine workup for all hospitalized psychiatric patients.

Adolescent↗
PubMed1981

The effectiveness of cardiology consultation. Concordance with diagnostic and drug recommendations.

In an effort to characterize the effectiveness of cardiology consultation, the outcomes of consultants' recommendations for diagnostic actions and cardiac drugs were quantitatively examined in 394 cases. Drug recommendations were made more frequently (49 percent) than diagnostic recommendations (38 percent) and were associated with a higher rate of concordance (82 percent to 64 percent). Recommendations to start therapy with a drug, especially an antihypertensive or an antianginal, were associated with a lower concordance rate than recommendations to continue or discontinue drug therapy. Consultees' responses to recommendations for diagnostic action did not vary significantly according to the type of action suggested. Nonconcordance with diagnostic suggestions was particularly high when a service made a large number of consult requests. Concordance was increased if the consultant left a follow-up note. Consultees' responses to drug and diagnostic recommendations were independent of one another. The study represents the first systematic assessment of cardiology consultation activities and provides a methodology for subsequent studies.

Adult↗
PubMed1980

Physical illness manifesting as psychiatric disease. II. Analysis of a state hospital inpatient population.

One hundred patients of lower socioeconomic class were intensively evaluated medically on a research ward for the presence of unrecognized medical illnesses that might have affected their hospitalization. Forty-six percent were thought to have medical illnesses that directly caused or greatly exacerbated their symptoms and were consequently responsible for their admission, while an additional 34% of patients were found to be suffering from a medical illness requiring treatment. A diagnostic battery of physical, psychiatric, and neurologic examinations, coupled with a 34-panel automated blood analysis, complete blood cell count, urinanalysis, ECG, and sleep-deprived EEG established the presence and nature of more than 90% of the illnesses detected, and is therefore recommended as an initial evaluation battery, particularly for patients facing involuntary commitment to a mental hospital.

Adolescent↗
PubMed1980

Consultees' concordance with consultants' psychotropic drug recommendations. Related variables.

In an attempt to identify variables critical to consultees' concordance with the recommendations of psychiatric consultants for the use of psychotropic medications in a general hospital, the medical records from 394 psychiatric consultations were reviewed. Using quantitative concordance criteria, consultee response was examined as a function of 29 variables. These characterized the patient, the consultee, the consultant, and the consultation. Seven variables were found to be significantly related to concordance. Among these were the patient's history of exposure to psychotropic medications, the presence of multiple recommendations, specification of starting dosage, the category of psychotropic drug recommendation, and the timing of the consultation. The latter two variables emerged as most noteworthy. This work extends the investigation of consultees' responses to consultants' recommendations and anticipates the development of specific consultation strategies derived from quantitative outcome studies.

Attitude of Health Personnel↗
PubMed1980

Consultees' concordance with consultants' recommendations for diagnostic action.

Consultees' concordance with psychiatric consultants' recommendations for diagnostic action was studied retrospectively. Of 381 initial consultations reviewd, 110 (29 per cent) contained one or more recommendations for diagnostic action. Consultees' responses were rated concordant in only 53 per cent of these cases. This disturbing outcome, reflecting broad resistance to consultants' practice of making recommendations for diagnostic action, is attributed to consultees' use of a functional vs. organic dichotomy regarding psychiatric disorder. The functional category is argued to be perceived by consultees as a nonmedical entity. As the psychiatrist is invoked to deal with this nonmedical entity, he is seen in other than the medical mode and inconsistently afforded medical privilege. The work implies how wide the gap to medical credibility may be for psychiatric consultants and the need for new consultation strategies incorporating this cognizance.

Adolescent↗
PubMed1980

Consultees' representations of consultants' psychiatric diagnoses.

In an attempt to characterize consultees' representations of consultants' psychiatric dagnoses, the authors reviewd the medical records from 190 psychiatric consultations in a general hopsital. Using specific outcome criteria, they rated 50% of representations as concordant and 39% as nonconcordant. Five variable,s icluding the primary medical diagnosis at discharge and the referring service, were significantly related to concordance. Surprisinlgy, concordance was independent of the psychiatric diagnosis, indicating theat consultees did not respond differentially to varying magnitudes and implications of the different disorders. This work raises the question of possible strategies to improve receptivity to psychiatric diagnoses in the consultation setting.

Attitude of Health Personnel↗
PubMed1980

Stress response syndrome occurring after delirium.

Psychiatric treatment of delirium usually focuses on behavioral management during the period of cognitive disturbance. Psychological sequelae have received less attention. The authors suggest that delirium represents a stressful life event that must be assimilated after the cognitive impairment has resolved. Such assimilation may be uniquely impaired because the patient lacks clear and correct information about the event. The authors propose that the psychiatric care of delirium include facilitation of the patient's efforts to obtain and assimilate information about the delirium after its resolution.

Delirium↗
PubMed1979

Physicians' concordance with consultants' recommendations for psychotropic medication.

Physicians' concordance with the recommendations of psychiatric consultants regarding the use of psychotropic medications in a general hospital was retrospectively examined in an outcome study. Using medical records in a series of 200 consecutive consultations, the authors found 68% of all psychotropic recommendations resulted in physician responses rated concordant and 24% nonconcordant. Resultant concordance ratings are presented according to category of recommendation (that is, start, adjust, continue, or discontinue) and drug groupings. The data suggest that drug group is not a critical variable in physician concordance. Responses did differ by category of recommendation. Further study of physician concordance is desirable. The work suggests both the potential of and need for outcome studies in consultation work.

Humans↗
PubMed1979

Presentation of the steroid psychoses.

This study suggests that patients receiving daily doses of 40 mg of prednisone or its equivalent, are at greater risk for developing steroid psychosis. Psychotic reactions were twice as likely to occur during the first 5 days of treatment as subsequently. Premorbid personality, history of previous psychiatric disorder, and a history of previous steroid psychosis did not clearly increase the patient's risk of developing psychotic reaction during any given course of therapy. Steroid psychoses present as spectrum psychoses with symptoms ranging from affective through schizophreniform to those of an organic brain syndrome. No characteristic stable presentation was observed in these 14 cases reported here. The most prominent symptom constellation to appear some time during the course of the illness consisted of emotional lability, anxiety, distractibility, pressured speech, sensory flooding, insomnia, depression, perplexity, agitation, auditory and visual hallucinations, intermittent memory impairment, mutism, disturbances of body image, delusions, apathy, and hypomania. Phenothiazines administered in average daily doses of 212 mg produced excellent response in all patients studied. Of particular note was the fact that tricyclic antidepressants produced an exacerbation or worsening of the clinical state in all patients to whom they were administered.

Adrenal Cortex Hormones↗
PubMed1978

Physical illness presenting as psychiatric disease.

A study of 658 consecutive psychiatric outpatients receiving careful medical and biochemical evaluation, defined an incidence of medical disorders productive of psychiatric symptoms in 9.1% of cases. The most frequent presentations were of depression, confusion, anxiety, and speech or memory disorders. The presence of visual hallucinations was believed to indicate medical etiology until proved otherwise. Major illnesses presenting with psychiatric symptoms in order of frequency were infectious, pulmonary, thyroid, diabetic, hematopoietic, hepatic and CNS diseases. Forty-six percent of these patients suffered from medical illnesses previously unknown to either them or their physician. A plea is made for careful medical evaluation of psychiatric patients.

Adult↗
PubMed1978

Single case study. A novel psychiatric adjunct to cancer therapy.

Confronted with the hazards of a patient unable to cooperate predictably with a 3-day radium implantation procedure as a part of cancer therapy, the authors describe in a case report their solution to an unusual clinical dilemma. The patient displayed adverse responses to psychotropics and nursing care was markedly restricted by radiation exposure limits. Behavioral management of the patient through the interval of radium therapy was successfully effected by the use of closed-circuit television monitoring combined with brief nursing interventions. This novel psychiatric adjunct to cancer therapy averted the threat posed by displacement of the radium implants.

Aged↗