Biomedical subjects

Raphael J. Leo

Publications and source records attributed to Raphael J. Leo.

7 recordsLinked to original sources

PubMed2003

Antidepressant Use in Chronic Pain Management: Is There Evidence of a Role for Duloxetine?

BACKGROUND: Duloxetine is a novel antidepressant that is anticipated to be clinically available soon. It exerts simultaneous noradrenergic and serotonergic neurotransmitter effects. Because of these influences, it is postulated to have a role in management of pain. DATA SOURCES: An Index Medicus search from 1997 to 2003 was conducted using the search terms duloxetine, Cymbalta, and pain. DATA ANALYSIS: Preclinical animal studies suggest that duloxetine may have a direct analgesic role. Premarketing studies have emphasized its utility in alleviating somatic, specifically pain, complaints among patients with major depression. CONCLUSION: Although promising, these results cannot be generalized to patients with pain disorders; the reasons for this are discussed herein. While duloxetine may be useful among somatizing depressed patients and possibly chronic pain patients with comorbid depression, its analgesic role has yet to be elucidated in future research.

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PubMed2003

Dr. Leo Replies.

Explore the source record for details and available documents.

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PubMed2001

Social Security Claims of Psychiatric Disability: Elements of Case Adjudication and the Role of Primary Care Physicians.

When first introduced into law, social security was designed to safeguard economic security for U.S. citizens who were retired or disabled. Primary care physicians are often contacted by the Social Security Administration (SSA) to provide clinical information about the impairments affecting their patients who have applied for disability. The disability determination process is often elusive to physicians. This article is written to describe the process involved in adjudicating disability claims according to SSA standards. Because psychiatric disturbances constitute the largest reason for applications for disability, this article addresses the sorts of information required of clinicians that would expedite disability adjudication of claims involving psychiatric disorders. Practical suggestions are offered for clinicians to employ when preparing medical reports. The potential impact of the disability claim on the doctor-patient relationship is also discussed.

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PubMed2000

Atypical Antipsychotic Use in the Treatment of Psychosis in Primary Care.

Atypical antipsychotics are a class of novel agents increasingly employed for the treatment of psychotic disorders. The pharmacodynamic properties of the atypicals appear to impact a broader spectrum of psychotic symptoms than had been appreciated with older generation antipsychotics. In addition, the atypical agents appear to have a reduced risk of neurologic side effects compared with conventional antipsychotic use. Both of these features enhance the appeal of the atypical antipsychotics and may be associated with enhanced patient compliance. The atypical antipsychotics appear to be effective for schizophrenia as well as other psychotic disorders, including schizoaffective disorder and mood disorders with psychotic features. Consequently, atypical antipsychotics are now considered to be the first-line treatment for schizophrenia, with the exception of clozapine, which is considered a second-line agent because of risks associated with its use. This review will discuss the literature on atypical antipsychotic efficacy in psychotic disorders. Issues related to antipsychotic use, dosing, adverse effects, and drug interactions are also discussed.

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PubMed1999

Psychogenic Respiratory Distress: A Case of Paradoxical Vocal Cord Dysfunction and Literature Review.

BACKGROUND: Pulmonary disease such as asthma is a psychosomatic disorder vulnerable to exacerbations precipitated by psychological factors. A case is described in which a patient thought to have treatment-refractory asthma was discovered to have a conversion reaction, specifically paradoxical vocal cord dysfunction (PVCD), characterized by abnormal vocal cord adduction during inspiration. DATA SOURCES: Reports of PVCD were located using a MEDLINE search and review of bibliographies. MEDLINE (English language only) was searched from 1966 through December 1998 using the terms functional asthma, functional upper airway obstruction, laryngeal diseases, Munchausen's stridor, paradoxical vocal cord dysfunction, psychogenic stridor, respiratory stridor, vocal cord dysfunction, and vocal cord paralysis. A total of 170 cases of PVCD were reviewed. STUDY FINDINGS: PVCD appears to be significantly more common among females. PVCD spans all age groups, including pediatric, adolescent, and adult patients. PVCD was most often misdiagnosed as asthma or upper airway disease. Because patients present with atypical and/or refractory symptoms, several diagnostic tests are employed to evaluate patients with PVCD; laryngoscopy is the most common. Direct visualization of abnormal vocal cord movement is the most definitive means of establishing the diagnosis of PVCD. A number of psychiatric disturbances are related to PVCD, including conversion and anxiety disorders. PVCD is associated with severe psychosocial stress and difficulties with modulation of intense emotional states. CONCLUSIONS: Psychogenic respiratory distress produced by PVCD can be easily misdiagnosed as severe or refractory asthma or other pulmonary disease states. Recognition of PVCD is important to avoid unnecessary medications and invasive treatments. Primary care physicians can detect cases of PVCD by attending to clinical symptoms, implementing appropriate laboratory investigations, and examining the psychological covariates of the disorder. Psychotherapy and speech therapy are effective in treating most cases of PVCD.

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PubMed1999

Anticonvulsant Use in the Treatment of Bipolar Disorder: A Primer for Primary Care Physicians.

Primary care physicians may be directly or indirectly involved in the management of the bipolar patient. Bipolar affective illness is a chronic, recurrent disorder. Patients, their families and support systems, and the general public can face profound and enduring consequences if the illness is untreated or poorly treated. Consequently, increasing attention has been directed at developing treatment strategies to control symptoms associated with bipolar disorder. While lithium has been the mainstay of treatment for many years, recent investigations have demonstrated the utility of a number of anticonvulsant medications in bipolar disorder. This review will discuss the literature on anticonvulsant efficacy in bipolar disorder in light of the treatment guidelines set forth by the Bipolar Treatment Expert Consensus Panel and the American Psychiatric Association. To orient the clinician, issues related to anticonvulsant use, dosing, adverse effects, and drug interactions are also discussed.

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PubMed1999

Competency and the Capacity to Make Treatment Decisions: A Primer for Primary Care Physicians.

Common law dictates that individuals possess autonomy and self-determination, which encompass the right to accept or refuse medical treatment. Management of medical treatment can be complicated in situations when the ability of the patient to make reasonable decisions is called into question. Our legal system endorses the principle that all persons are competent to make reasoned decisions unless demonstrated to be otherwise. This review will discuss the standards upon which capacity and competency assessments are made. Practical suggestions are offered for clinicians to employ in patient interviews conducted to assess capacity. Issues related to advance directives, surrogate decision making, guardianship, and implied consent are also discussed. The role psychiatric consultants take in capacity assessment can assist the primary care physician confronting the complexities encountered when attempting to treat the incapacitated or incompetent patient.

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