Strategies for diagnosing and treating agitation in the aging.
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Biomedical subjects
Publications and source records attributed to M Raskind.
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Fluphenazine enanthate parenterally was compared to an antipsychotic drug (haloperidol) given orally for the "crisis intervention" treatment of elderly outpatients with late paraphrenia. In the fluphenazine group, 11 of 13 patients improved, compared to only 3 of 13 in the oral drug group (p less than 0.01). The superiority of fluphenazine probably was attributable to improved compliance with the prescribed regimen by patients receiving parenteral depot medication. Despite the advanced age of the subjects, significant adverse drug effects were uncommon.
Young and old healthy subjects with indwelling venous cannulae were found to undergo significant diurnal variations in plasma catecholamine levels. Both norepinephrine and epinephrine levels peaked in late morning and reached lowest values at night during sleep. Catecholamine levels were similar during slow wave and rapid eye movement sleep. While epinephrine levels were unaffected by age, norepinephrine levels were greater in older subjects by 28% during the day (at 1100 h; P less than 0.01) and by 75% at night (between 2200--0900 h; P less than 0.01). Older subjects slept less well; they had 90% less stage 4 sleep, 27% less rapid eye movement sleep, and twice as much wakefulness at night (P less than 0.05). These findings raise the possibility that this well known age effect on sleep may be related to increased sympathetic nervous system activity.
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This study examined the effects of combat exposure and posttraumatic stress disorder (PTSD) on dimensions of anger in Vietnam veterans. Vietnam combat veterans were compared with Vietnam era veterans without war zone duty on the Multidimensional Anger Inventory (MAI). Combat veterans were not significantly more angry than their veteran peers who did not serve in Southeast Asia. Additionally, various parameters of war zone duty were not highly associated with anger scores. However, combat veterans with PTSD scored significantly higher than veterans without PTSD on measures of anger arousal, range of anger-eliciting situations, hostile attitudinal outlook, and tendency to hold anger in. These results suggest that PTSD, rather than war zone duty, is associated with various dimensions of angry affect.
There is disagreement about whether depressive symptoms in schizophrenia are part of the basic disease process, or whether they represent adverse effects of treatment with antipsychotic medications. In a sample of initially antipsychotic drug-free acutely hospitalized patients with schizophrenia (N = 104), we measured change in depressive symptoms after 4 weeks of treatment. We also examined the relationship of changes in depressive symptoms to changes in positive and negative schizophrenic symptoms. Depressive symptoms improved after 4 weeks of antipsychotic medication treatment, and their improvement corresponded with improvement in both positive and negative schizophrenic symptoms. These results suggest that depressive symptoms in schizophrenia are related to the disease process itself, at least during acute exacerbations of schizophrenia. Depressive symptoms may be responsive to antipsychotic medications directly or as a secondary response to improvement in positive and negative symptoms.
The purpose of this study was to examine the effects of a 2-hour laboratory challenge on heart rate, blood pressure, catecholamines, and cortisol; and investigate the contribution of the physical act of speaking on both neuroendocrine and cardiovascular measures. Using a within-subjects design, 14 subjects were tested individually during two separate laboratory sessions. During one session, subjects engaged in two cognitively demanding tasks for 2 hours. During the other session, subjects executed the verbal demands of the tasks for 2 hours, but cognitive demands were absent. During both sessions, blood pressure and heart rate were measured and arterialized blood samples were obtained for the measurement of epinephrine, norepinephrine, and cortisol. Subjects demonstrated significantly greater increases in systolic blood pressure diastolic blood pressure, heart rate, epinephrine, and cortisol during the cognitively challenging session than during the control session. It is concluded that sustained elevations in cardiovascular and neuroendocrine measures can be achieved in the laboratory, and that the effects of such tasks cannot be attributed solely to the physical demands of speaking. Implications for the measurement of circulating catecholamines and cortisol during laboratory studies are discussed.