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Biomedical subjects

R Pary

Publications and source records attributed to R Pary.

At least 19 recordsLinked to original sources
PubMed1996

Treatment of insomnia. Getting to the root of sleeping problems.

Insomnia may be periodic and transient, as caused by situational stress, or persistent, as caused by a chronic sleep disorder. Physicians can gain much information concerning the type, probable cause, onset, and duration of insomnia through history taking. A sleep diary may reveal helpful information, and input from the patient's sleeping partner can also be valuable. Complicating disorders, such as heart failure, prostatism, or depression, should be sought and specific treatment prescribed. Chemical dependency, too, requires appropriate treatment. These measures, institution of good sleep-hygiene practices, and behavior modification may resolve sleeplessness. The primary indication for use of hypnotic agents is transient sleep disruption caused by acute stress. When an agent is chosen, onset of action, metabolism, and side effects should be considered, especially in elderly patients. Addictive agents should not be given to patients with substance abuse problems. If insomnia persists, evaluation at a sleep-disorder center is recommended to facilitate design of an appropriate therapeutic regimen.

Anti-Anxiety Agents↗
PubMed1994

Obsessive-compulsive disorder. How to free patients from intrusive thoughts and rituals.

The antidepressants clomipramine hydrochloride (Anafranil), fluoxetine hydrochloride (Prozac), and sertraline hydrochloride (Zoloft) are the main choices for pharmacologic treatment of obsessive-compulsive disorder. Often, drug doses for obsessive-compulsive disorder are higher than for depression, and improvement occurs more slowly and is often only partial. Behavior therapy involving exposure to feared objects or situations and prevention of ritualistic behavior complements pharmacologic treatment. Referral to a behavioral therapist may be necessary to achieve recovery.

Antidepressive Agents↗
PubMed1993

Psychoactive drugs used with adults and elderly adults who have mental retardation.

During 12 months, the charts of 369 subjects were reviewed. A significantly increased prevalence of use of psychoactives occurred in those subjects 55 years and older compared to those 20- to 39-years of age. The 40- to 54-year group also had increased prevalence rates compared to the younger group, suggesting a trend for increasing psychoactive use by middle age adults. The increased psychoactive use by the elderly adults was associated with independent living and psychiatric diagnosis. Neuroleptics were also significantly increased for elderly individuals living under family supervision. Antiparkinsonian drugs had significantly greater prevalence in elderly adults than in the 20- to 39-year group and was associated with psychiatric diagnosis. Limitations of the study were discussed.

Adult↗
PubMed1993

Mental retardation, mental illness, and seizure diagnosis.

The coexistence of epilepsy in individuals with mental retardation and mental illness is common. Little is known about whether individuals with all three conditions do significantly worse on inpatient units compared to persons with mental retardation and psychiatric disorder but without a seizure diagnosis. During 62 consecutive months, 247 individuals with mental retardation and psychiatric disorders were discharged from a university hospital. A review of discharge summaries yielded 39 individuals with a seizure diagnosis. The only difference between the groups with and without seizures was level of mental retardation. No differences existed with regard to length of stay, transfer to state hospital, psychiatric co-morbidity, or medical illness. Although it is sometimes difficult for many individuals with mental retardation to be admitted to a psychiatric hospital during exacerbations of mental illness, they should not be further stigmatized by presence of a seizure diagnosis.

Adult↗
PubMed1992

Pharmacologic treatment strategies for the depressed, poorly responsive patient.

Treatment-resistant depression implies a failure of response to an ample dose of antidepressant medicine, prescribed over a sufficient length of time. Assessing drug levels in the blood is often helpful in confirming the adequacy of antidepressant dosages. Augmentation of the pharmaceutical activity can be achieved by coadministration of lithium, triiodothyronine, and/or stimulants. Neuroleptics are also prescribed with the antidepressant when psychotic features accompany depression. Such enhancements to drug efficacy are usually an advantage over beginning a new medication because of shorter response time. When a decision is made to change the antidepressant, a structurally different option is more likely to induce a remission than a medication of similar configuration. Electroconvulsive therapy is the most powerful treatment choice for depressed patients, especially when suicidal or psychotic features are present.

Antidepressive Agents↗
PubMed1992

Identifying and treating patients with panic attacks.

Panic disorder occurs in up to 3 percent of the population and can be socially, emotionally and occupationally disabling. A thorough clinical evaluation is crucial to exclude illnesses with similar presentations, particularly acute cardiac, gastrointestinal or neurologic disease. The noradrenergic nervous system is involved in panic attacks. These attacks are described as sudden, unexpected episodes of intense fear or discomfort, usually lasting five to 30 minutes. Appropriate medications include benzodiazepines, tricyclic antidepressants and monoamine oxidase inhibitors. Alprazolam and clonazepam are quickly effective in alleviating panic, but they cause significant symptoms upon discontinuation. The best-studied drug in the treatment of panic disorder is imipramine; like other tricyclic antidepressants, it can cause increased jitteriness early in treatment. Monoamine oxidase inhibitors may be particularly helpful in patients with panic disorder who exhibit social avoidance. Behavior therapy, an important component of treatment, involves the patient's confrontation of fears or phobias.

Behavior Therapy↗
PubMed1992

Preventing suicide in older people.

Prompt recognition of suicidal intent can prevent suicide in the elderly. Some psychiatric disorders, such as depression, psychoses and organic brain syndromes, can predispose these persons to suicide, as can medical disorders that result in pain, disability or dysfunction. Other factors that increase the risk for suicide include chemical dependency and changing life events. Anti-depressant medications with a low anticholinergic and sedative profile are preferred because of age-related physiologic changes. Electroconvulsive therapy is reserved for serious cases.

Aged↗
PubMed1991

Side effects during lithium treatment for psychiatric disorders in adults with mental retardation.

Previous clinical trials using lithium with individuals who have mental retardation have not emphasized the incidence of side effects. During a 58-consecutive-week period at an outpatient clinic for adults with psychiatric illness and mental retardation or borderline intellectual functioning, 67% (10 out of 15) patients had side effects. The percentage is similar to reports of side effects during lithium treatment in the general population. Results suggest that adults with mental retardation who take lithium may be as prone to side effects as those in the general population.

Adult↗
PubMed1990

Dementia: what to do.

Dementia is a syndrome of acquired intellectual deterioration that interferes with personal or social functioning. Diagnosis requires historical information from the family and the mental status evaluation of orientation, recent memory, comprehension, calculation, and abstraction. Most dementias create permanent, even progressive cognitive deterioration, yet there are some presentations for which remission exists. Common reversible conditions include depression, drug toxicity, normal-pressure hydrocephalus, hypothyroidism, subdural hematoma, and neoplasm. Screening laboratory studies consist of urinalysis, chemistry profile, blood count, thyroid survey, vitamin B12 and folate measurements, serology, chest roentgenogram, computerized tomographic scan of the head, electroencephalogram, and electrocardiogram. Treatment focuses on potential reversibility, psychosocial issues, restoring deficits, and specific symptoms.

Cognition Disorders↗
PubMed1990

Risk factors for white matter changes detected by magnetic resonance imaging in the elderly.

We found increased age (p = 0.001) and history or evidence of stroke (p = 0.016) to be significant independent multivariate predictors of the presence and severity of leukoencephalopathy on magnetic resonance imaging brain scans in a mixed population of 35 elderly psychiatric patients and 25 neurologically healthy elderly volunteers. These results suggest that subcortical ischemia, as well as age-related changes that may not be vascular in origin, contribute to the emergence of periventricular and other deep white matter hyperintensities that are commonly seen on the magnetic resonance imaging brain scans of older adults.

Aged↗
PubMed1989

Dementia in the elderly.

When are confusion and forgetfulness transient signs of normal aging, when are they signs of depression or a medical illness, and when are they signs of dementia? The authors describe clinical features and diagnostic studies that help establish the presence of dementia and discuss ways of coping with both remediable and less treatable types.

Aged↗
PubMed1989

Alcoholism in the elderly. How to spot and treat a problem the patient wants to hide.

Alcoholism is a disease that warrants a complete medical workup and vigorous intervention in all age-groups, including the elderly. Increased awareness of the problem, with early diagnosis and treatment, can reduce mortality and morbidity. Alcoholics are at risk for relapse, so physicians should be patient and positive in their approach. Especially in the elderly, obtaining a list of all prescribed and over-the-counter medications used is an important starting point. Nonessential drugs should be discontinued and use of any others closely monitored. If a withdrawal syndrome results from discontinuation of alcohol, thiamine, multivitamins, and sedatives should be prescribed as clinically indicated. Treatment of any underlying psychiatric disorder is important. Psychosocial intervention is essential in dealing with recovering elderly alcoholics to overcome loneliness and to enhance sobriety. A formal rehabilitative effort is mandatory. Long-term rehabilitation focuses on group support and may include use of disulfiram (Antabuse).

Aged↗
PubMed1989

Fluoxetine: prescribing guidelines for the newest antidepressant.

Fluoxetine is an antidepressant drug with a unique chemical configuration which enhances serotoninergic transmission by inhibiting serotonin uptake. The chronic presence of serotonin in the synaptic cleft reduces postsynaptic receptors, a postulated explanation for its antidepressant efficacy. Comparative studies show that the therapeutic effectiveness of fluoxetine is equal to that of imipramine, amitriptyline, and doxepin. A 20 mg morning dose alleviates most depressions. The long half-life of one to three days for the parent compound and seven to 15 days for the active metabolite, desmethylfluoxetine, is largely unaffected by age or renal impairment. Nausea, nervousness, insomnia, and headache are the most common side effects. Therapeutic doses do not affect cardiac conduction or cause orthostasis. A primary benefit of this drug is its significant relative safety in overdoses as compared to other antidepressants.

Depressive Disorder↗
PubMed1988

Psychiatric disorders in the elderly. Psychopharmacologic management.

Psychiatric management of elderly patients is a challenging task because of the many age-related physiologic changes and medical problems in this population. Thorough patient evaluation is essential to rule out somatic disorders and determine underlying causes. Somatic complaints must be taken seriously, even if a patient is receiving treatment for a psychiatric disorder. Psychotropic therapy is used mainly for controlling depression, agitation, and psychotic symptoms. If psychiatric symptoms persist or become worse, psychotropics should be discontinued to prevent possible drug toxicity (eg, anticholinergic delirium) and psychiatric consultation should be requested.

Aged↗