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Biomedical subjects

S I Finkel

Publications and source records attributed to S I Finkel.

At least 19 recordsLinked to original sources
PubMed2001

Behavioral and psychological symptoms of dementia: a current focus for clinicians, researchers, and caregivers.

Behavioral and psychological symptoms of dementia are an important aspect of dementing illness. They represent a growing burden to caregivers and health care institutions and an increasing financial burden as the proportion of elderly patients, and consequently those with dementia, increases throughout the world. Behavioral and psychological symptoms of dementia can be recognized and assessed using a number of rating scales. Management of the symptoms is then possible for the benefit of patients, family members, caregivers, and the health care system.

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PubMed1999

Nimodipine potentiates the light-induced suppression of melatonin.

In mammals the phase shifting response of the circadian clock to light can be enhanced by administration of the calcium channel antagonist nimodipine. In the present study we assessed the potential for nimodipine to affect the responsiveness of the human circadian clock to light by measuring the light-induced suppression of melatonin levels in plasma. Seven healthy young subjects (3M, 4F, 27.3 +/- 1.8 years old) were admitted on four occasions to the Clinical Research Center at Northwestern University Medical School. Blood was collected during the night to assess the effect of nimodipine (30 mg, orally, 01:30 h) on plasma melatonin levels in the presence or absence of light (500 lux, 2-3 am). Melatonin levels in plasma were measured by radioimmunoassay. Exposure to light for 1 h suppressed melatonin levels in plasma by nearly 38% relative to samples obtained at the same time in the absence of light (P = 0.013). Nimodipine administration did not modify plasma melatonin levels. However, combined treatment with nimodipine and light suppressed melatonin levels in plasma by 59%. Levels of plasma melatonin were significantly lower following treatment with nimodipine and light than following treatment with placebo/light (P = 0.014). Thus, the calcium channel antagonist nimodipine potentiated the suppressive effect of light on melatonin levels in plasma. These results suggest that the calcium channel antagonist nimodipine may also potentiate the response of the human circadian clock to light, and might thus be useful in combination with phototherapy for the treatment of sleep and circadian rhythm disorders.

Adult↗
PubMed1999

Comparative efficacy and safety of sertraline versus nortriptyline in major depression in patients 70 and older.

BACKGROUND: Few randomized, double-blind studies that examine antidepressant treatment in patients 70 years and older are available. To provide additional data on the safety and efficacy of antidepressants in this rapidly growing population segment, a subgroup analysis of a larger sertraline vs. nortriptyline elderly depression treatment study was performed. METHODS: Outpatients (N = 76) who met DSM-III-R criteria for major depression with a minimum Hamilton Depression Rating Scale (HAM-D) severity score of 18 were randomized to 12 weeks of flexible dose treatment with sertraline (50-150 mg) or nortriptyline (25-100 mg). RESULTS: Both treatments significantly improved depression as measured by the HAM-D and Clinical Global Impression scales. At Weeks 10, 12, and endpoint, sertraline demonstrated a significantly greater reduction in depression severity compared to nortriptyline as measured by improvement on the 24-item HAM-D (mean adjusted change score of 14.8 vs. 7.6, respectively, at Week 12; p = .001). Sixty-five percent of sertraline-treated patients were responders by Week 12 (50% or greater reduction from baseline in 24-item HAM-D score) compared to 26% of nortriptyline-treated patients (p < .05). Sertraline treatment had a significantly more positive effect, when compared to nortriptyline, across almost all associated measures of cognitive function, energy, anxiety, and quality of life and was better tolerated than nortriptyline, with a lower attrition rate/side effect burden. CONCLUSION: The efficacy advantage of sertraline appeared to be even greater in this subgroup of older patients drawn from a larger treatment study of depression that included elderly individuals over the age of 60.

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PubMed1999

Comparative efficacy of sertraline vs. fluoxetine in patients age 70 or over with major depression.

Using data from a larger 12-week clinical trial, the authors evaluated the comparative efficacy and safety of sertraline (n=42) and fluoxetine (n=33) in patients over age 70 with a diagnosis of major depressive disorder. Similar improvement on measures of depression, including remission of depressive symptoms, was evident, although significantly more sertraline-treated patients achieved a criterion clinical response. Significantly greater improvement for the sertraline group was apparent on the Digit Symbol Substitution Test, but not on two other measures of cognitive functioning. Although there was no difference in the rate of adverse events experienced, fluoxetine-treated patients lost significantly more body weight over the 12-week trial than did sertraline-treated patients, whereas the latter group exhibited significantly more "shaking. "

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PubMed1998

Psychotherapeutic agents in older adults. Antipsychotics: old and new.

As the number of older adults worldwide continues to increase markedly, the absolute increase in their numbers means that there also will be a substantial increase in the number of older people with mental disorders. These disorders include several that manifest psychotic symptoms. Many credit the substantial reduction in the number of older people in state mental hospitals over the past 40 years primarily to the advent of antipsychotic (neuroleptic) medication. Although the traditional neuroleptic medications often are effective, they also are associated with troublesome side effects. Newer neuroleptic medications appear to be just as effective but have fewer adverse side effects.

Age Factors↗
PubMed1997

History and physical examination of elderly patients with dementia.

The role of the physician is critical in the evaluation of cognitively impaired patients for two reasons: (a) The longitudinal relationship between the patient and physician provides a unique opportunity to observe changes over time, generating confidence that may encourage the patient and family to report any concerns; (b) All research in this field is geared toward the earliest possible intervention, a process made possible by early diagnosis. Preparations for interview and the interview process itself require special knowledge of dementia on the part of the evaluating physician, who must understand the potentials and problems of both the content the process of taking a history from the demented patient and his/her caregivers.

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PubMed1997

Managing the behavioral and psychological signs and symptoms of dementia.

As the world's population ages, increasing numbers of patients with dementia can be expected, the signs and symptoms of which can be extremely disruptive. In particular, behavioral and psychological signs and symptoms of dementia reduce the quality of life of carers (usually family members) and increase the cost of care. Conventional neuroleptics have been used for many years in the management of disturbed and disruptive demented patients, although there are few well-controlled clinical trials demonstrating their efficacy. The use of the low-potency neuroleptics is associated with orthostatic hypotension, cardiac toxicity, anticholinergic side effects and daytime sedation. The high-potency neuroleptics tend to cause extrapyramidal side effects and akathisia. Clozapine although less likely to cause extrapyramidal symptoms than conventional neuroleptics, can cause orthostatic hypotension and requires continual blood monitoring. Early-phase open trials suggest that risperidone is efficacious in patients with behavioral and psychological signs and symptoms of dementia and that it has a low side-effects profile. Further trials are needed to confirm this, but it is likely that the newer antipsychotics, as typified by risperidone, will lead to safer and more effective management of patients with the disruptive and costly behavioral and psychological signs and symptoms of dementia. Non-pharmacologic interventions may also provide benefit, though controls are rare.

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PubMed1996

Clinical experiences and methodologic challenges in conducting clinical trials on the behavioral disturbances of dementia.

With a world population increasing in size and age, the number of elderly people with behavioral disturbances in dementia (BDD) is becoming an increasing problem. The burden of caring for someone with BDD may be so great that it leads to premature institutionalization of the patient. Few clinical trials have focused on noncognitive behavioral symptoms in this group of elderly patients, and little is known about the efficacy of drugs against these symptoms. The pharmaceutical companies have recently begun to assess different medications, but clinical trials in the elderly present a variety of problems not encountered in other patient populations. This article describes how the administration, initiation, logistics, finances, and methodology of such trials must be carefully assessed. Consideration of these factors together with improved definitions of behavioral symptoms and the advances in medication in this area should lead to an improvement in the treatment and management of behavioral disorders in the elderly.

Behavior↗
PubMed1996

Efficacy and tolerability of antidepressant therapy in the old-old.

As the number of elderly increases worldwide, there will be a concurrent increase in the absolute number of people over 70 years of age who suffer from major depressive disorders. There is a paucity of research in this old-old population, although each of the following drugs has been studied in at least one clinical drug trial: amitriptyline, bupropion, dothiepin, fluoxetine, mianserin, nortriptyline, paroxetine, and sertraline. The results to date, though limited, suggest similar efficacy and greater tolerability of serotonin selective reuptake inhibitors compared with tricyclic antidepressants in the elderly.

Age Factors↗
PubMed1995

Six elderly suicides in a 1-year period in a rural midwestern community.

In a 1-year period, 6 of 11 suicides in a rural Wisconsin county were committed by people over the age of 60. At the request of the local coroner, the American Medical Association sent a team of investigators to perform psychological autopsies. Family member survivors, friends, and attending physicians were interviewed. The majority of suicide victims had evidence of major depressive episodes, delusions that they had a terminal physical illness, and knowledge of family/friends who had committed suicide. Most had seen their physician within 48 hours before their death. Continuing education efforts focused on increasing a physician's abilities to recognize depression and suicidal ideation have ensued, based on this experience.

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PubMed1995

Validity of the Severity of Psychiatric Illness rating scale in a sample of inpatients on a psychogeriatric unit.

Previous efforts to define the case mix of psychiatric inpatients have generally relied on the use of psychiatric diagnosis, and have had little success elucidating the relationship between clinical outcome and resource utilization. The Severity of Psychiatric Illness (SPI) rating scale, a reliable chart-based system using nine clinical rating dimensions, has been developed by one of the authors for use in studying the case mix of psychiatric inpatients. This report is the first describing this scale. For a sample of 244 psychogeriatric patients, all but one of the dimensions were significantly correlated with at least one of the five baseline clinical assessments, and all but one of the SPI items were correlated with outcome assessment. Four dimensions of the SPI were related to clinical outcomes. The SPI also predicted length of stay (predicting 23% of the variance for patients discharged to their homes). This study provides strong evidence for the construct and predictive validity of the SPI among older adult psychiatric inpatients.

Activities of Daily Living↗