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Biomedical subjects

M Tohen

Publications and source records attributed to M Tohen.

107 records · Page 6Linked to original sources
PubMed1991

Thrombocytopenia associated with carbamazepine: a case series.

Carbamazepine is increasingly being used in the acute and maintenance treatment of patients with bipolar disorder. Thrombocytopenia represents a serious adverse effect of carbamazepine with which clinicians need to be familiar. The authors describe the course of thrombocytopenia associated with carbamazepine in four patients with bipolar disorder. In all cases, thrombocytopenia appeared 14 to 16 days after the initiation of carbamazepine; also in all cases the platelet count completely recovered within 7 days after the carbamazepine treatment was discontinued. Thrombocytopenia secondary to carbamazepine appears soon after the initiation of treatment and is rapidly followed by recovery after drug discontinuation.

Adolescent↗
PubMed1990

Outcome in Mania. A 4-year prospective follow-up of 75 patients utilizing survival analysis.

A 4-year follow-up of 75 patients was conducted to investigate outcome after recovery from an episode of mania. Predictors of an unfavorable outcome included poor occupational status prior to index episode, history of previous episodes, history of alcoholism, psychotic features and symptoms of depression during the index manic episode, male gender, and interepisode affective symptoms at 6 months' follow-up. The mortality risk during the follow-up period was 4%. The identification of specific risk factors depended on the definition of outcome and the length of follow-up.

Adult↗
PubMed1990

Four-year follow-up of twenty-four first-episode manic patients.

Twenty-four first-episode manic patients were followed to investigate the 4-year outcome after recovery from a manic episode. Patients had no documented previous manic or depressive episodes. The presence of psychotic features during the index episode and a history of alcoholism were statistically significant predictors of a shorter time in remission. Low occupational status at baseline predicted poor global social adjustment at 4 years. Also, a larger correlation among outcome measures was found at 48 than at 6 months. The importance of controlling for presence of multiple episodes in outcome studies is emphasized.

Bipolar Disorder↗
PubMed1988

Is there a long-term protective effect of mood-altering agents in unipolar depressive disorder?

Major depression is common, often severe, and usually recurrent, and it carries an excess risk of mortality due to medical illness as well as suicide. At referral centers, recurrence risk averages 85% within 2-3 years of full recovery from an acute episode. The natural history of major depression is highly variable, but typically episodes las ca. 6 months, with cycles of ca. 2 years. Yet, most long-term treatment studies are limited to the year or two following recovery from an acute episode. Accordingly, available evidence best supports a relapse-preventing effect of tri-cyclic antidepressants or lithium within the first months after apparent recovery but is less compelling regarding prevention of later recurrences of new episodes. Other treatments have not been evaluated systematically. The hypothesis that bipolarlike, but apparently unipolar, patients might respond selectively to lithium maintenance requires further testing. Knowledge of long-term dose-benefit and dose-risk relationships is starting to emerge for lithium, but these relationships remain inadequately tested for antidepressants. Actual levels of clinical treatment of major depression appear to fall short of the ideal, and much additional research and education is required to improve care in this very common disorder.

Antidepressive Agents↗
PubMed1988

Symptoms and functioning of patients with bipolar disorder six months after hospitalization.

The relationship between symptoms and functioning of patients with bipolar disorder who were hospitalized for a manic episode was examined in a prospective study. At six-month follow-up, symptomatic outcome was clearly superior to functional outcome. Almost 80 percent of patients were symptom free or mildly symptomatic. However, only 43 percent of patients were employed, and only 21 percent were working at their expected level of employment. Thirty percent were rated as being unable to work. Additional analyses showed that 64 percent of the first-admission subjects were employed at some level at follow-up, compared with only 33 percent of subjects with multiple admissions. The results suggest that factors other than symptoms are related to the functioning of patients with bipolar disorder and that treatment should be targeted to the patient's disability as well to symptom amelioration.

Adolescent↗
PubMed1988

Long-term response to carbamazepine: a retrospective study.

Carbamazepine is now used by many clinicians in the treatment of bipolar disorder (BD) refractory to standard treatments, including lithium and neuroleptics. Little information is yet available about the utility and efficacy of this novel treatment during long-term use. We carried out a retrospective study of 50 patients (34 with BD) who had received carbamazepine for the treatment of a psychotic disorder. Two-thirds (22) of the BD patients and two of the 16 patients with other diagnoses appeared to respond to carbamazepine acutely. However, follow-up 3 to 4 years later revealed that only eight patients (seven with BD) were still receiving the drug. In only two cases was the treating psychiatrist convinced that carbamazepine was clearly beneficial. Side effects, particularly hematological abnormalities, during both short- and long-term treatment were troublesome. Carbamazepine may only infrequently be useful in the long-term care of patients who fail to respond to standard treatment.

Adult↗
PubMed1985

An empirical study of psychosis in borderline personality disorder.

To assess the nature and prevalence of psychotic symptoms in borderline personality disorder, the authors reviewed the cases of 33 patients meeting DSM-III criteria for borderline personality disorder, using both "narrow" and "broad" definitions of psychosis. Only eight patients displayed psychotic symptoms meeting the "narrow" DSM-III definition; in all of these cases, the symptoms appeared to be attributable to either severe drug abuse or major affective disorder, present simultaneously with borderline personality disorder. The remaining patients displayed only "broadly defined" psychotic symptoms or symptoms that appeared to be under voluntary control. These findings weigh against the assumption that borderline personality disorder lies "on the border" of classical psychotic disorders.

Adolescent↗
PubMed1984

Open trial of S-adenosylmethionine for treatment of depression.

Nine depressed inpatients completed trials with S-adenosylmethionine. Seven showed improvement or remission of their symptoms. As in European studies, no side effects were seen except the apparent induction of mania in two patients with bipolar disorder.

Adult↗
PubMed1983

Preparation for the certification examination.

The authors present their view of the oral certification examination of the Royal College. They found that preparation for the examination was educational, and that the examination itself was fair. Some suggestions to prospective candidates are offered.

Canada↗
PubMedDate not supplied

Structural brain abnormalities in first-episode mania.

Using magnetic resonance imaging (MRI), we studied brain morphometric differences between patients with first-episode mania (n = 17) and normal control subjects (n = 16). Patients were admitted for their first psychiatric hospitalization and met DSM-III-R criteria for bipolar disorder, manic or mixed. Diagnoses were made using the Structured Clinical Interview for DSM-III-R. Patients and control subjects were matched for age, gender, height, past history of substance abuse, and handedness, although control subjects had attained higher levels of education. MRI inversion recovery coronal scans were used for measurements. Volumetric measurements were obtained for cerebral hemispheres, lateral and third ventricles, caudate, thalamus, and cingulate gyrus. Patients with first-episode mania demonstrated significantly larger third-ventricular volumes, possibly increased lateral ventricular volumes, and differences in gray/white matter distribution compared with normal control subjects. The possible pathophysiological meaning of these findings is discussed.

Adolescent↗
PubMedDate not supplied

Transfer of psychiatric inpatients to a general hospital due to adverse drug reactions.

The authors review their experience with transfers of hospitalized psychiatric inpatients to general hospitals because of adverse drug reactions (ADRs). A total of 29 medical transfers related to ADRs were found in a review of 10,994 psychiatric inpatient admissions that occurred in a 30-month period between 1990 and 1993 (0.264%). Most cases involved neurological syndromes (76%), particularly delirium (31%). Low-potency antipsychotic agents were most frequently implicated (31%). Most ADRs were of moderate severity, but 8 cases required medical hospitalization (0.07% incidence). These findings indicate that ADRs leading to transfer of hospitalized psychiatric patients to a general medical facility were infrequent (< 0.3% of psychiatric admissions) and rarely led to medical hospitalization (< 0.1%).

Adult↗
PubMedDate not supplied

Discontinuation of maintenance treatment in bipolar disorder: risks and implications.

There is abundant evidence for substantial long-term prophylactic efficacy of lithium in bipolar manic-depressive disorders. Interruption of such treatment carries an extraordinarily high risk of recurrence within several months, even after several years of stability. Even a sharp reduction in dose may carry some risk. Gradual discontinuation of lithium was accompanied by markedly reduced risk of early recurrence. There is suggestive evidence that the phenomenon of high risk of recurrence after abrupt interruption of maintenance treatment may occur with other disorders and treatments, including neuroleptics in schizophrenia and possibly antidepressants in recurrent depression. The phenomenon of discontinuation-associated iatrogenic risk of early recurrence of major psychiatric illness has clear clinical implications. These include the need to evaluate safer methods of interrupting long-term maintenance treatment, particularly when clinical indications for rapid cessation are compelling and gradual discontinuation is not feasible. Questions also arise concerning interpretation of existing experimental studies of maintenance treatments that require interruption of treatment, reduction of dose, or crossover to a placebo, as well as the ethical and scientifically unambiguous design of future studies of this kind.

Antimanic Agents↗
PubMedDate not supplied

Telephone versus in-person clinical and health status assessment interviews in patients with bipolar disorder.

We evaluated the correspondence between in-person- and telephone interview-derived data on affective symptoms, health-related quality of life, disability days, and medication compliance in patients with bipolar disorder. Twenty-eight outpatients with DSM-III-R-documented bipolar disorder were randomly assigned to an initial in-person or telephone interview. An average of 4.0 days later, they were reassessed by the other interview method. Results indicate good to excellent agreement between telephone and in-person interviews on measures of mania (intraclass correlation coefficient (ICC) = 0.92) and depression symptoms (ICC = 0.90), suicide risk (kappa = 0.80), and alcohol use (kappa = 0.61), scores on the Medical Outcomes Study 36-item Short-Form Health Survey (ICCs = 0.66-0.92), and medication compliance (ICCs = 0.50-0.66). Measures of bed disability days (ICC = 0.34) and restricted activity days (ICC = 0.66) showed less agreement. Telephone interviews are feasible and reliable for collecting data on psychiatric and other health-related outcomes in bipolar disorder patients.

Adult↗
PubMedDate not supplied

The effect of comorbid substance use disorders on the course of bipolar disorder: a review.

Population-based studies have documented that among all patients with major psychiatric disorders, those with bipolar disorder have the highest prevalence of comorbid substance abuse and dependence. The cause of this high comorbidity rate has not been clearly established, and the relationship is probably bidirectional. Articles published in English from 1980 through 1997 containing the terms comorbidity, mania, outcome, and substance use were identified by searching Medline and then the bibliographies of the articles identified in this search. The literature review showed several risk factors to be associated with comorbid substance use disorders in bipolar disorder patients: early age of onset, gender, family history of substance use disorders, and presence of mixed mania. Methodological enhancements that have helped to advance understanding in this area include distinguishing between primary and secondary disorders, between the different subtypes of bipolar disorder, and between first and subsequent episodes of illness. In order to determine the temporal sequence of onset, longitudinal studies initiated at the onset of either illness need to be pursued. Increased understanding of the association between bipolar disorder and comorbid substance use disorder will facilitate improved detection and intervention, as well as more-effective preventive measures that could improve outcome for patients with bipolar disorder.

Adolescent↗