PubMed Health⌕ Search

Biomedical subjects

T A Stern

Publications and source records attributed to T A Stern.

At least 19 recordsLinked to original sources
PubMed1999

A staff dialogue on do not resuscitate orders: psychosocial issues faced by patients, their families, and caregivers.

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a non-profit organization dedicated to supporting and advancing compassionate health care delivery which provides hope to the patient, support to caregivers, and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. The following case of a woman who developed lymphoma was discussed at the July and August, 1997 Schwartz Center Rounds. There were considerable delays and uncertainties in the diagnosis, which was followed by an unpredictably chaotic clinical course. Although she had made it clear to her doctor that she did not want "heroic measures," she had unexpectedly rallied so many times that her son and her husband wanted her doctors to do everything possible to keep her alive, including the performance of cardiopulmonary resuscitation (CPR). The clinical benefit of CPR in the event of cardiac arrest in those with cancer is discussed, as are do not resuscitate (DNR) orders, living wills, and healthcare proxies. In addition, the issues that surround DNR status, including who should discuss DNR status with a patient, and how and when it should be discussed, are reviewed. Staff raised concerns about the effect of discussing DNR status on the doctor-patient relationship, and wondered whether writing DNR orders adversely affect the care of patients.

Advance Directives↗
PubMed1998

Dizziness and panic disorder: a review of the association between vestibular dysfunction and anxiety.

Dizziness is a common and costly condition that causes significant distress and impairment yet often confounds appropriate diagnosis and treatment. Among patients presenting for evaluation and treatment of dizziness, rates of panic disorder are elevated to 5 to 15 times the general population rates. In addition, the limited studies to date of dizziness in patients with panic disorder suggest that panic patients frequently experience significant dizziness and often demonstrate evidence of vestibular dysfunction. In this paper we review studies investigating the relationship between panic disorder and vestibular dysfunction. Currently, there are three main explanatory models for the association between panic disorder and vestibular dysfunction: the psychosomatic model, the somatopsychic model, and the network alarm theory. Systematic investigations of the treatment of patients with vestibular symptoms and panic disorder are lacking, though prevalence, associated costs, and disability suggest that they are needed. Serotonin selective reuptake inhibitors are good candidates for future treatment studies.

Agoraphobia↗
PubMed1996

Management of the prescription-drug-dependent adult: case of meprobamate abuse and its treatment.

Misuse of prescription drugs in the elderly can be a serious problem that is difficult to manage. Prescriptions for non-narcotic central nervous system (CNS) depressants (e.g., anxiolytics and sedative-hypnotics) are commonly written, and their use is associated with severe intoxication and withdrawal effects. The presence of comorbid psychiatric conditions (e.g., depression or panic disorder), for which these agents are prescribed frequently, complicates the clinical picture. This paper, using case examples of meprobamate abuse, describes how physicians can recognize, manage, and treat a patient who is abusing a non-narcotic CNS depressant.

Adult↗
PubMed1996

Failure to record delirium as a complication of intra-aortic balloon pump treatment: a retrospective study.

This study was conducted to determine whether or not diagnosis and treatment of delirium among patients treated with the intra-aortic balloon pump (IABP) correlates with the recording of this complication on discharge records. Since prior episodes of delirium are one of the few clear risk factors for future episodes of delirium, accurate recording of delirium on the discharge summary and list of discharge diagnoses is useful to clinicians. A retrospective review of the charts of all patients (N = 198) who underwent placement of an IABP during 1988; assessment of the type and frequency of medical and neuropsychiatric complications during IABP treatment; and comparison of chart review findings with the Massachusetts General Hospital's computer-generated lists of discharge diagnoses for the same IABP-treated patients was completed. Only 12% of patients diagnosed and treated for delirium had delirium recorded as a discharge diagnosis. In contrast, 44% and 52% of patients who had been diagnosed and treated for cerebrovascular accident and pneumonia, respectively, had these diagnoses recorded among the discharge diagnoses. Receiving a discharge diagnosis of organic brain syndrome increased the likelihood that delirium was recorded as a discharge diagnosis. Delirium is underdiagnosed as a complication associated with IABP-treatment and is under-reported on the list of discharge diagnoses, even when it is diagnosed. Further study is warranted to determine if making the diagnosis of delirium during a patient's hospital course and recording it is a complication at the time of discharge is translated into a higher level of preparedness by physicians during subsequent hospitalizations.

Aged↗
PubMed1995

Neuroleptic malignant syndrome associated with clozapine treatment.

Although not universally accepted, evidence exists that clozapine treatment may be associated with neuroleptic malignant syndrome (NMS). To date, 10 cases of NMS associated with the use of clozapine have been reported in the literature. We report two more cases of NMS in patients on clozapine treatment and review the clinical presentations, biochemical features, risk factors, treatment, and rechallenge with neuroleptics in all reported patients who developed NMS while receiving clozapine treatment. An update and critical review of clozapine-induced NMS are also presented. Clozapine treatment can cause NMS similar to that induced by conventional neuroleptics. A history of NMS, existing brain insults, low serum iron concentrations, and being a young male may be risk factors for the development of NMS associated with clozapine treatment. NMS most commonly occurs when clozapine is being used along with other psychotropics. Early recognition of the syndrome and cessation of clozapine when NMS occurs are advised. Supportive care and use of dopamine agonists and dantrolene may be helpful in treating clozapine-associated NMS. These results support the notion that clozapine can cause NMS. However, NMS associated with clozapine treatment is a rare event. When it happens, the clinical presentation, risk factors, and management appear to be similar to those of NMS associated with conventional neuroleptics.

Adult↗
PubMed1993

Management of delirium associated with use of the intra-aortic balloon pump.

Five patients who developed an agitated delirium in association with use of an intra-aortic balloon pump are presented. The differential diagnosis of delirium in critically ill cardiac patients is reviewed and effective pharmacologic treatment strategies (involving rapid and aggressive management with intravenous haloperidol) are discussed.

Administration, Oral↗
PubMed1992

Electroconvulsive therapy treatment of depression in a patient with adult GM2 gangliosidosis.

Adult GM2 gangliosidosis is a rare disorder that often presents with both neurological and psychiatric syndromes. Effective treatment of the psychotic and affective symptoms associated with this disorder has been complicated by poor treatment response and the concern that many psychotropic agents may worsen the underlying gangliosidosis. We report the successful use of electroconvulsive therapy for treatment of severe depression in a young man with adult GM2 gangliosidosis.

Adult↗
PubMed1992

Pros and cons of fluoxetine for the depressed cancer patient.

When major depression develops in patients with cancer, specific antidepressant treatment should be initiated. Fluoxetine (Prozac) is one of several effective treatments for depression; it is currently the most frequently prescribed antidepressant in the United States. Unfortunately, the information from studies and reports regarding the use of fluoxetine in patients with cancer is limited. This article reviews the properties, drug interactions, and side-effect profiles of fluoxetine and the other antidepressants most relevant to the care of cancer patients. Also discussed are strategies for the prudent prescription of fluoxetine, the tricyclic antidepressants, and the psychostimulants in depressed cancer patients.

Antidepressive Agents↗
PubMed1992

Recognition and management of benzodiazepine dependence.

Primary care physicians prescribe the majority of benzodiazepines and thus may see most patients who are dependent on these drugs. The diagnosis of benzodiazepine misuse is based on the history, the physical examination and drug use patterns. The treatment of benzodiazepine misuse can be a challenging process that requires the physician's patience, caution and sound clinical judgment. Patients who misuse benzodiazepines may have coexisting psychiatric problems that require treatment, such as depression or panic disorder. Family physicians can manage these patients but should be prepared to refer them for hospitalization when habituation and withdrawal reactions are complicated by medical instability, noncompliance or clinical deterioration.

Ambulatory Care↗
PubMed1991

The evaluation of homicidal patients by psychiatric residents in the emergency room: a pilot study.

The authors report the results of a preliminary prospective study involving 110 patients who were involuntarily committed from the emergency room. The study was designed to clarify the process of how psychiatric residents evaluate homicidal patients. Eighteen patients (16%) were committed for homicidal ideation, of whom 89% were psychotic. Surprisingly, for patients committed because of a risk of homicide, vital signs were obtained for only 11%, during a mean evaluation time of 2.5 hours. Aspects of an appropriate physical examination and laboratory studies that enable the clinician to distinguish organic from functional illness are described. The authors conclude that patients with homicidal ideation may receive inadequate assessment prior to their involuntary commitment. Possible explanations and solutions for this, and recommendations for further studies are offered.

Adolescent↗