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Biomedical subjects

T A Stern

Publications and source records attributed to T A Stern.

At least 37 records · Page 2Linked to original sources
PubMed1991

Neuropsychiatric considerations in the treatment of hypertension.

Algorithms have been developed to guide the treatment of simple hypertension. The basic algorithms are modified in the face of concurrent medical conditions, taking into account the various pharmacological effects of antihypertensive agents. This article reviews the neuropsychiatric effects of the major classes of antihypertensive agents (ganglionic blockers, centrally acting agents, diuretics, vasodilators, beta-blockers, calcium channel blockers and angiotensin converting enzyme inhibitors). The purported efficacy of some antihypertensive agents in the treatment of psychiatric conditions is also discussed. Beneficial as well as adverse neuropsychiatric effects are reviewed. In this way, guidelines for the treatment of hypertension are suggested which take into account a broad spectrum of neuropsychiatric considerations.

Antihypertensive Agents↗
PubMed1990

Quantitative serum toxic screening in the management of suspected drug overdose.

Data were collected on 176 consecutive cases of drug overdose evaluated in an emergency department. Quantitative serum toxic screening (TS) was performed for 164 (93%) of these patients; positive results were noted for 133 patients (81%). Six classes of drugs (ethanol, benzodiazepines, salicylates, acetaminophen, barbiturates, and tricyclic antidepressants) were responsible for nearly 70% of all drug detections and were associated with 80% of all admissions in this patient sample. Only two patients (1%) had drug-specific treatment initiated because of TS results. In 12 patients (7%), TS confirmed substances for which specific treatments had been initiated on clinical grounds. Four patients (2%) had drug-specific treatment discontinued because of TS results. Thirty-two patients (19%) were admitted to a medical service; however, only seven patients (4%) were admitted primarily because of TS results. All other patients were admitted because of clinical abnormalities that required inpatient care. It is concluded that only a few drugs are responsible for most drug overdoses. Moreover, TS results rarely change the treatment or disposition of overdose patients; these decisions are typically based on clinical parameters.

Acetaminophen↗
PubMed1990

Adverse cardiac effects of combined neuroleptic ingestion and tricyclic antidepressant overdose.

During a retrospective review of 70 consecutive intensive care unit admissions for tricyclic antidepressant (TCA) overdose, we identified 12 patients (17%) who had simultaneously ingested a neuroleptic agent. We then compared several clinical and laboratory features of patients who had ingested TCAs alone with those patients who had also taken a neuroleptic drug. The 12 patients in the TCA-neuroleptic group, when compared with patients in the TCA-only group, showed a markedly higher prevalence of first-degree atrioventricular block (p less than 0.001), a significantly higher prevalence of prolongation of the QRS duration (greater than 0.10 sec) (p less than 0.05), and a threefold increase in the prevalence of QTc prolongation (p less than 0.05). Our data indicate that coingestion of neuroleptics and TCAs, when compared with the ingestion of TCA alone, may significantly increase the risk of adverse cardiac consequences. We discuss the possible mechanisms for these electrocardiographic changes as well as their potential implications.

Antidepressive Agents, Tricyclic↗
PubMed1988

Depression and diabetic neuropathy: a complex relationship.

In a group of 64 non-insulin-dependent diabetic females, a significant positive correlation between Zung self-rated depression scores and objective measurements of diabetic peripheral neuropathy was limited to those women with Zung scores greater than 50 (depressed group, n = 12). In the overall group, there was no significant linear or quadratic relationship between peripheral neuropathy and depression scores. The associations between depression, peripheral neuropathy, and diabetes are discussed.

Blood Glucose↗
PubMed1988

Treatment of anxiety associated with electrophysiologic studies.

Programmed electrical stimulation, also known as electrophysiologic studies (EPS), is a cardiologic technique used to help guide physicians in their management of selected patients with cardiac arrhythmias. Data are presented for 14 consecutive patients undergoing EPS seen in psychiatric consultation who had a diagnosis related to anxious mood. Successful management strategies, which evolved from work with these patients, included psychologic approaches (supportive psychotherapy and education) and psychopharmacologic agents (most commonly alprazolam). EPS and related physiologic aspects of anxiety and stress are briefly reviewed.

Adult↗
PubMed1987

Psychiatric management of acute myocardial infarction in the coronary care unit.

Failure to recognize and treat the psychiatric complications of myocardial infarction (MI) may aggravate the underlying cardiac condition and interfere with its treatment. The timing and manifestations of several distinct psychiatric conditions that commonly accompany the acute phase of MI (anxiety, depression, delirium, and behavioral abnormalities secondary to a person's premorbid character style) will be reviewed. In addition, the importance of psychological risk factors for the development of coronary artery disease (e.g., life stress and the Type A behavior pattern) and the impact of denial on the cardiac patient's condition will be discussed. Management strategies that include nonpharmacologic (i.e., support, reassurance, brief psychotherapy and cardiac rehabilitation) and psychopharmacologic interventions (e.g., the rational use of benzodiazepines, antidepressants and neuroleptic agents) for psychiatric conditions in the MI patient will be provided. Postdischarge issues that occur in both the patient and his or her family are outlined, and the enrollment in cardiac rehabilitation programs is encouraged.

Antidepressive Agents↗
PubMed1986

Fear of choking.

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Adult↗