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Biomedical subjects

Nicholas Keks

Publications and source records attributed to Nicholas Keks.

6 recordsLinked to original sources
PubMed2006

The acutely psychotic patient--assessment and initial management.

BACKGROUND: Acute psychosis is a medical emergency; apart from distress and behavioural dysfunction, there may be danger to the patient and others. Urgent assessment and management is essential. Although involvement of specialist services is usual, general practitioners may need to initiate initial treatment and, in more remote areas, provide complete care. OBJECTIVE: This article aims to update the GP about the initial management of the acutely psychotic patient. DISCUSSION: General practitioners will frequently be the initial source of assistance for patients with acute psychosis and their families. The patient with first episode psychosis may pose particular challenges, especially as insight about the need for treatment is often poor. The first step is to establish a therapeutic alliance, enabling history, examination and investigations. While it is necessary to establish the presence of psychosis, precise diagnosis is usually a secondary consideration. Risk assessment must be carried out to decide whether the patient can be managed in the community or needs inpatient care.

Acute Disease↗
PubMed2005

Assessment of cognitive function in heart failure patients.

BACKGROUND: Research on the cognitive capacity of heart failure patients is limited, with a paucity of benchmark information available for this population. It is highly likely that cognitive deficits affect patients' understanding of disease and treatment requirements, as well as limiting their functional capacity and ability to implement treatment plans, and undertake self-care. AIMS: The purpose of this study was to establish a comprehensive neurocognitive profile of the heart failure patient through systematic neurocognitive assessment and to determine whether an association existed between severity of heart failure and cognitive abilities. METHODS: Thirty-eight patients were recruited from the heart failure patient databases of two metropolitan hospitals in Melbourne, Australia. Participants were individually assessed using four standardised, internationally recognised neuropsychological tests that examined current and premorbid intelligence, memory and executive functioning. RESULTS: Although there was no significant decline from premorbid general intellectual function, other specific areas of deficit, including impaired memory and executive functioning, were identified. There were no significant correlations between heart failure severity and the neurocognitive measures used. CONCLUSION: The results support the need to recognise cognitive impairment in people with heart failure and to develop an abbreviated method of assessing cognitive function that can be easily implemented in the clinical setting. Identifying cognitive deficits in this population will be useful in guiding the content and nature of treatment plans to maximise adherence and minimise worsening of heart failure symptoms.

Activities of Daily Living↗
PubMed2004

Managing schizophrenia in general practice.

BACKGROUND: The lifetime risk of schizophrenia is about one in 100. It is an illness associated with substantial disability and increased risk of physical illness. OBJECTIVE: This article updates general practitioners on the physical, psychological and social management of patients with schizophrenia. DISCUSSION: General practitioners have a key role in managing patients with schizophrenia, including early detection of prodromal symptoms, monitoring and preventing relapses, and providing high quality primary and secondary prevention for common physical problems. Effective care requires a thorough understanding of local specialist services, pharmacotherapies, and familiarity with psychosocial interventions that will genuinely benefit patients.

Adult↗
PubMed2003

Olanzapine vs risperidone in the management of schizophrenia: a randomized double-blind trial in Australia and New Zealand.

Improved drug therapy for schizophrenia may represent the best strategy for reducing the costs of schizophrenia and the recurrent chronic course of the disease. Olanzapine and risperidone are atypical antipsychotic agents developed to meet this need. We report a multicenter, double-blind, parallel, 30-week study designed to compare the efficacy, safety, and associated resource use for olanzapine and risperidone in Australia and New Zealand. The study sample consisted of 65 patients who met DSM-IV criteria for schizophrenia, schizoaffective disorder, or schizophreniform disorder. Olanzapine-treated patients showed a significantly greater reduction in Positive and Negative Syndrome Scale (PANSS) total, Brief Psychiatric Rating Scale (BPRS) total, and PANSS General Psychopathology scores at endpoint compared to the risperidone-treated patients. Response rates through 30 weeks showed a significantly greater proportion of olanzapine-treated patients had achieved a 20% or greater improvement in their PANSS total score compared to risperidone-treated patients. Olanzapine and risperidone were equivalent in their improvement of PANSS positive and negative scores and Clinical Global Impression-Severity of Illness scale (CGI-S) at endpoint. Using generic and disease-specific measures of quality of life, olanzapine-treated patients showed significant within-group improvement in most measures, and significant differences were observed in favor of olanzapine over risperidone in Quality of Life Scale (QLS) Intrapsychic Foundation and Medical Outcomes Study Short Form 36-item instrument (SF-36) Role Functioning Limitations-Emotional subscale scores. Despite the relatively small sample size, our study suggests that olanzapine has a superior risk:benefit profile compared to risperidone.

Adult↗