Biomedical subjects

Michael Privitera

Publications and source records attributed to Michael Privitera.

7 recordsLinked to original sources

PubMed2005

Violence toward mental health staff and safety in the work environment.

BACKGROUND: An increasing number of violent episodes toward staff were noted at a university department of psychiatry. A multidisciplinary committee was formed consisting of psychiatrists, biostatisticians, psychologists, nurses, administrators, data managers, social workers, security services, educators on personal safety and an attorney to address the problem. AIM: To determine the prevalence of violence toward mental health staff, clinicians and non-clinicians, the trend of violence over time, gather more detail about the violent events, the personal struggle of staff affected and establish suggestions for intervention. METHODS: A workplace violence survey was designed to query staff experiences of endangerment, threats, assaults, age, sex and discipline, years in the field, treatment setting, sense of safety and proclivity to press charges. RESULTS: Of 742 surveys distributed, respondents returned 380 (response rate 51%). Forty-three percent of respondents reported being threatened and 25% assaulted. Threats and assaults increased significantly (P<0.001) over all the time periods queried based on Poisson regression analysis. Work experience was a protective factor (P<0.001), but not a guarantee against violent events. CONCLUSION: Threats and assaults on mental health staff have a substantial prevalence and are increasing in our psychiatric population. Practical recommendations derived from our study but in need of further research for confirmation are: (1) multidisciplinary personal safety training to enhance team-building, improve communication and help prevent violent events and (2) establishment of post-event protocols to assist staff-victims and administrators navigate through complex issues occurring after violent events.

Adult↗

PubMed2005

The effect of age and structural lesions on postictal language impairment.

The duration of postictal language dysfunction following a temporal lobe complex partial seizure (TLCPS) is longer when the seizure originates in the dominant hemisphere. However, the effects of older age and the presence of a structural lesion ipsilateral to the area of origin of the seizure remain unknown. Postictal language delay (PILD) was analyzed in relation to age and presence of a structural lesion in 47 patients, 28 with dominant TLCPSs and 19 with nondominant TLCPSs (total 173 seizures). Mean ages of the groups were 32.5 years (range: 16-68) and 36.1 years (range: 21-50), respectively. Nonsclerotic structural lesions were found by magnetic resonance imaging in 13 patients, eight with seizures in the dominant hemisphere and five with seizures in the nondominant hemisphere. Age did not affect PILD regardless of the lateralization of the seizures. The presence of a structural lesion significantly prolonged PILD only in the patients with nondominant TLCPS (p = 0.019). In conclusion, the anatomical site of seizure onset may not be the only determinant of the nature of the postictal state. PILD can provide important information on seizure localization and spread.

Adolescent↗

PubMed2004

Human blood genomics: distinct profiles for gender, age and neurofibromatosis type 1.

Application of gene expression profiling to human diseases will be limited by availability of tissue samples. It was postulated that germline genetic defects affect blood cells to produce unique expression patterns. This hypothesis was addressed by using a test neurological disease-neurofibromatosis type 1 (NF1), an autosomal dominant genetic disease caused by mutations of the NF1 gene at chromosome 17q11.2. Oligonucleotide arrays were used to survey the blood gene expression pattern of 12 NF1 patients compared to 96 controls. A group of genes related to tissue remodeling, bone development and tumor suppression were down-regulated in NF1 blood samples. In addition, there were blood genomic patterns for gender and age: Y chromosome genes showing higher expression in males, indicating a gene-dosage effect; and genes related to lymphocyte functions showing higher expression in children. The results suggest that genetic mutations can be manifested at the transcriptional level in peripheral blood cells and blood gene expression profiling may be useful for studying phenotypic differences of human genetic diseases and possibly providing diagnostic and prognostic markers.

Adolescent↗

PubMed2004

Language dysfunction after frontal lobe partial seizures.

Postictal language delay (PILD) patterns can lateralize temporal lobe complex partial seizures (CPS). The authors studied PILD in 24 patients with 118 frontal lobe CPS. Prolonged PILD occurred in only 7% of CPS confined to the dominant frontal lobe compared with 91% of CPS that started as frontal and spread to the dominant temporal lobe (p = 0.0001). Postictal language testing provides important information on frontal CPS localization and spread.

Adolescent↗

PubMed2004

Levetiracetam induces a rapid and sustained reduction of generalized spike-wave and clinical absence.

BACKGROUND: Levetiracetam (LEV) is a new antiepileptic drug with efficacy in partial-onset seizures. We report a case in which generalized-onset absence seizures responded clinically and electrographically to LEV. METHODS: We evaluated with continuous video/electroencephalography an adult with generalized-onset seizures given 3 antiepileptic drugs, 1 of which was LEV. Levetiracetam initiation 2 months before admission decreased patient-reported seizures. Interictal electroencephalography revealed generalized 3.5-Hz spike-wave and polyspike-wave discharges. Spike-wave bursts lasting 2 seconds or longer caused a pause in continuous reading aloud, consistent with clinical absence seizures. Levetiracetam was discontinued on admission, lamotrigine was gradually discontinued across 2 days, and topiramate was not changed. One encephalographer counted from video/electroencephalography recordings the number of spike-wave bursts in 1-hour time samples that included wake and sleep time. RESULTS: Spike-wave bursts increased from 4 to 56 per hour at baseline (4000 mg of LEV per day) to 406 to 914 per hour less than 48 hours after LEV discontinuation. Levetiracetam treatment was restarted, and 3 hours after the first dose of 1000 mg, spike-wave bursts dropped to 135 per hour. Response was sustained during the next 2 days. CONCLUSIONS: This case showed a dramatic, rapid effect of LEV discontinuation and reinstitution on generalized spike-wave burst frequency and clinical absence. The effects were independent of reduction of lamotrigine and without change in topiramate doses and occurred in a time course consistent with LEV pharmacokinetics. Levetiracetam may be effective in generalized-onset epilepsy, and randomized, controlled trials are indicated.

Adult↗

PubMed2004

Assessment of adverse events and quality of life in epilepsy: design of a new community-based trial.

Improving health-related quality of life (HRQOL) has become recognized as an essential component of treating patients with epilepsy. In recent years, several rating scales have been developed that focus on both common adverse effects and various aspects of HRQOL that are more relevant to this patient population. Increasingly, such assessments are being incorporated into clinical trials, as it becomes clear that improvements in overall quality of life are an important feature of drug therapy. Here we present the design of a large, community-based trial evaluating the effects of switching from immediate-release carbamazepine to twice-daily, beaded, extended-release carbamazepine (Carbatrol). As this trial involves switching formulations of the same compound, we expect to find only small differences in efficacy but significant differences in tolerability and quality-of-life measures. To identify appropriate instruments that could measure these factors, here we review several epilepsy-specific scales used to monitor adverse events and HRQOL and discuss their potential utility in the context of the proposed trial.

Anticonvulsants↗

PubMed2002

What does the family pictures subtest of the Wechsler Memory Scale-III measure? Insight gained from patients evaluated for epilepsy surgery.

The Family Pictures (FP) task is a new subtest of the Wechsler Memory Scale Version III (WMS-III) used to assess visual memory and learning. This study assessed the extent to which different cognitive abilities contribute to performance on the FP task in 125 patients evaluated for epilepsy surgery. Results indicated that the FP task relies heavily on auditory-verbal based cognitive abilities, as well as visual memory, and may better represent a general measure of memory performance. These results raise questions about the appropriateness of including FP task performance in the calculations of the WMS-III Visual Index scores.

Adult↗