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Biomedical subjects

P J Barreira

Publications and source records attributed to P J Barreira.

10 recordsLinked to original sources
PubMed2001

Insurance status and length of stay for involuntarily hospitalized patients.

General and private psychiatric hospitals are becoming increasingly common as sites for involuntary hospitalization. Unlike the public facilities that these settings are supplanting, these hospitals must pay strict attention to issues associated with reimbursement, insurance status, and managed care. This article examines the effects of insurance status on length of stay for involuntarily hospitalized patients in general and private hospitals in Massachusetts. Using a two-stage sampling procedure, data on episodes of involuntary hospitalization were gathered and assessed using multiple regression. The primary effect was found between patients with Medicare, who had the longest stays, and individuals who were uninsured, who had the shortest. The data raise concerns that warrant closer scrutiny on the part of administrators and clinicians.

Adult↗
PubMed2001

Long-stay patients in state psychiatric hospitals at the end of the 20th century.

OBJECTIVES: The purpose of this study was to assess the characteristics of long-stay patients in contemporary state psychiatric hospitals and to identify factors representing possible barriers to alternative placements for these patients. METHODS: All patients in inpatient units of the Massachusetts Department of Mental Health who had been hospitalized for at least three years as of April 1, 1999, were assessed by their treatment teams with a standardized data collection instrument. Domains assessed included medical problems, need for nursing care, psychiatric diagnosis, and history of problematic behaviors. RESULTS: The 330 individuals identified as long-stay patients had an array of medical problems and nursing care needs that likely would have been manageable in other long-term-care settings. A total of 276 patients had at least one significant medical problem. However, some patients exhibited behavioral problems that might have complicated such placements, especially when behavioral problems co-occurred with the need for medical supervision. A total of 228 patients had exhibited a significant problematic behavior in the previous 30 days. CONCLUSIONS: Although the number of long-stay patients in state psychiatric hospitals declined dramatically during the second half of the 20th century, a small group of patients still requires care in this setting. State psychiatric hospitals continue to occupy a significant niche in the mental health system.

Female↗
PubMed1994

Obsessive-compulsive disorders in Pick's disease.

The authors present a follow-up of a previously described patient with obsessive-compulsive disorder (OCD). Her condition continued to worsen, and she died 5 years after disease onset. Neuropathological findings were consistent with the diagnosis of Pick's disease. They revealed, in addition to the "knife-edge" frontotemporal atrophy, striking atrophy with extensive neuronal loss and gliosis involving the caudate nuclei and, to a lesser degree, the putamens and globus pallidus. Neuroimaging data had showed isolated atrophy of the caudate nuclei in the early stages of Pick's disease in this patient when OCD was the leading clinical manifestation. Relevant literature is reviewed, and the role of caudate nuclei atrophy in the development of OCD is discussed.

Adult↗
PubMed1988

The clinical vs. research paradox in psychopharmacological research.

Research to date suggests a general equivalence of efficacy of the various types of antidepressant drugs across the patient population. However, clinicians deal daily with the fact that there is little or no drug equivalence for any given patient, who may respond positively to one antidepressant but not to others. The paradox may result from the paucity of studies that focus on individual variation in drug response.

Antidepressive Agents↗
PubMed1984

Comparison of metoprolol and propranolol in the treatment of akathisia.

Metoprolol was compared to propranolol in the treatment of neuroleptic-induced akathisia by means of an on-drug/off-drug crossover study. Both beta-blockers were effective, but the usefulness of metoprolol was limited by side effects due to the high dose of this medication required to produce a therapeutic effect. The mechanism of action of beta-blockers in the treatment of akathisia is discussed in light of the different pharmacologic properties of metoprolol and propranolol. The study results suggest that these agents are effective in reducing akathisia through a central mechanism of action requiring beta-2 blockade.

Adolescent↗
PubMed1984

Propranolol in the treatment of neuroleptic-induced akathisia.

Fourteen patients with neuroleptic-induced akathisia were treated with propranolol in an open trial. All patients demonstrated substantial improvement of their akathisia; nine of the 14 obtained complete remission. Response was quite rapid, occurring within 24 hours in most cases. Doses required for improvement were low (30-80 mg/day), and side effects were few. Lithium-induced tremor improved considerably, but symptoms of parkinsonism and tardive dyskinesia showed little change. Preliminary results with certain other beta blockers suggest that they are less effective than propranolol in the treatment of akathisia.

Adolescent↗
PubMed1983

The dexamethasone suppression test in psychotic disorders.

Dexamethasone suppression tests were given to 69 consecutively admitted psychiatric patients. Nonsuppression rates for depression with or without melancholia and for schizophrenia were similar to those previously reported, but for mania and other psychoses the frequencies were higher than expected.

Adolescent↗
PubMed1983

A clinical report of thymoleptic-responsive atypical paranoid psychoses.

The paranoid disorders of five patients remitted after treatment with thymoleptic agents despite the absence of a full affective syndrome. Their clinical symptoms at admission included suspiciousness, hypervigilance, ideas of reference, hostility, belligerence, and delusions of persecution or of infidelity. Some had phasic disturbances with somatic complaints or prominent phobic anxiety symptoms, a family history of affective disorder, or prior responses to thymoleptic drugs. These observations suggest that some patients with paranoid psychosis who do not have a full DSM-III affective syndrome may respond to antidepressant pharmacotherapy alone, i.e., without neuroleptics. Systematic, prospective studies of this phenomenon would help to ascertain diagnostic criteria for such patients and the range of therapeutic responses.

Adult↗