Biomedical subjects

T Ditzler

Publications and source records attributed to T Ditzler.

5 recordsLinked to original sources

PubMed1997

Pharmacological management of post-traumatic stress disorder: clinical summary of a five-year retrospective study, 1990-1995.

Beginning in 1990, the Department of Psychiatry. Tripler Army Medical Center developed a formal treatment program for post-traumatic stress disorder (PTSD). Between 1990 and 1996, 632 patients, the vast majority of whom suffered from combat-related PTSD, were treated. Historically, many PTSD patients were treated with benzodiazepines, often in high dosages. The risks attendant to benzodiazepine management of PTSD, coupled with poor clinical outcome, prompted the staff to explore treatment alternatives. This paper describes the role of pharmacotherapy in the management of PTSD. The medications described in this paper have other primary uses in clinical practice (e.g., hypertension, insomnia, seizure control, depression, and anxiety). Medications were selected for use based on the putative modes of action and the degree of symptom relief. The therapeutic rationale was to decrease hyperarousal and sleep disturbance to permit the patients to engage in other psychotherapeutic efforts.

Adrenergic alpha-Antagonists↗

PubMed1995

Contribution of obesity to defects of intracellular glucose metabolism in NIDDM.

OBJECTIVE: To examine the contribution of obesity to insulin resistance and abnormalities of intracellular glucose and fat metabolism in NIDDM. RESEARCH DESIGN AND METHODS: Glucose turnover measurements and indirect calorimetry were performed in 10 obese non-insulin-dependent diabetes mellitus (NIDDM) and 10 lean NIDDM subjects (body mass index 35.3 +/- 1.0 vs. 24.1 +/- 0.5 kg/m2, P < or = 0.001) in the basal state and during hyperinsulinemic (720 pmol.m-2.min-1) euglycemic (5.0-5.5 mmol/l) clamps. RESULTS: Obese and lean NIDDM subjects demonstrated similar basal rates of glucose uptake (GU) (1.15 +/- 0.08 vs. 1.26 +/- 0.08 mmol/min, NS) as well as oxidative (0.49 +/- 0.07 vs. 0.53 +/- 0.05 mmol/min, NS) and nonoxidative (0.67 +/- 0.10 vs. 0.73 +/- 0.12 mmol/min, NS) glucose metabolism. During hyperinsulinemic glucose clamp studies, rates of GU were lower in obese NIDDM subjects (34.1 +/- 2.3 vs. 55.2 +/- 3.8 mumol.kg fat-free mass [FFM]-1.min-1, P < or = 0.001) as were rates of oxidative (14.1 +/- 1.3 vs. 22.1 +/- 2.1 mumol.kg FFM-1.min-1, P < or = 0.005) and nonoxidative (20.0 +/- 2.3 vs. 33.1 +/- 3.6 mumol.kg FFM-1. min-1, P < or = 0.01) glucose metabolism. Although absolute rates of insulin-stimulated GU were decreased in the obese group, the relative distribution into glucose oxidation (GOX) and nonoxidative glucose metabolism (NOX) was comparable in both groups (GOX 42% in obese and 41% in lean subjects; NOX 58% in obese and 59% in lean subjects). The NIDDM groups had similar basal free fatty acid levels that were suppressed equally during hyperinsulinemic clamps. However, basal fat oxidation (Fox) was greater in the obese NIDDM group (103 +/- 11 vs. 73 +/- 8 mumol/min, P < or = 0.05) and was less suppressed to insulin (74 +/- 13 vs. 16 +/- 3 mumol/min, P < or = 0.001). CONCLUSIONS: These results indicate that when obesity is present in NIDDM subjects with this degree of hyperglycemia, insulin-stimulated GU is lower by 35-40%. Reduced GU in obese NIDDM subjects leads to decreased intracellular substrate availability and lower rates of oxidative and nonoxidative glucose metabolism. Insulin suppression of Fox is also impaired when obesity is present and may contribute to decreased insulin-mediated GU in NIDDM. We conclude that obesity increases insulin resistance in NIDDM primarily by effects on GU rather than the intracellular pathways of glucose metabolism.

Adipose Tissue↗

PubMed1993

Assessing alcoholic denial. Further examination of the Denial Rating Scale.

The reliability, validity, and heuristic value of Goldsmith and Green's (J. Nerv. Ment. Dis. 176:614-620, 1988) Denial Rating Scale (DRS) are examined in an inpatient treatment setting. This replication study includes 647 cases. The same strong relationship between clinical change and program completion as found by Goldsmith and Green is identified. An ordinal predictive validity for the DRS regarding program completion that was not found by Goldsmith and Green is also identified. Utility for improving patient treatment plans through DRS results is identified. The heuristic value of the DRS in helping an alcoholism counseling staff maintain treatment focus is discussed. It is recommended that treatment centers incorporate systematic assessment of denial over the course of treatment as a means to facilitate staff focus on the primacy of addiction.

Adolescent↗

PubMed1993

Intensive conventional insulin therapy for type II diabetes. Metabolic effects during a 6-mo outpatient trial.

OBJECTIVE: To determine whether tight glycemic control can be obtained using intensive conventional split-dose insulin therapy in the outpatient management of type II diabetes without development of unacceptable side effects. RESEARCH DESIGN AND METHODS: Fourteen type II diabetic subjects were treated with an intensive program of conventional insulin (subcutaneous NPH and regular insulin before breakfast and supper) for 6 mo. Insulin dose adjustments were based on an algorithm built on frequent CPG measurements (4-6 times/day). Patients were monitored biweekly as outpatients and admitted 1 day/mo for metabolic evaluation. RESULTS: Glycemic control was achieved by 1 mo (mean plasma glucose fell from 17.5 +/- 0.9 to 7.7 +/- 0.7 mM, P < 0.001) and remained in this range thereafter. Hypoglycemic events at 1 mo were infrequent (mean +/- SE events per patient per month: 4.1 +/- 0.3) and mild in nature, and progressively decreased to 1.3 +/- 0.5 events/mo by 6 mo. After treatment, basal HGO fell 44% from 628 +/- 44 to 350 +/- 17 mumol.m-2.min-1 (P < 0.001), and maximal rates of glucose disposal measured by hyperinsulinemic euglycemic clamp (1800 pmol.m-2.min-1) improved from 1418 +2- 156 to 1657 +/- 128 mumol.m-2.min-1 (P < 0.05). The total dose of exogenous insulin required was 86 +/- 13 U at 1 mo and 100 +/- 24 U at 6 mo. During treatment, mean serum insulin levels increased from 308 +/- 80 to 510 +/- 102 pM (P < 0.05), while body weight increased from 93.5 +/- 5.8 to 102.2 +/- 6.8 kg (P < 0.001). Both pre- and posttreatment glucose disposal rates correlated with the total exogenous insulin dose required to achieve glycemic control (r = -0.75 and -0.78, both P < 0.005). Weight gain was inversely related to the pretreatment glucose disposal rate (r = -0.53, P < 0.05) and directly correlated with both mean day-long serum insulin level (r = 0.67, P < 0.01) and total exogenous insulin dose (r = 0.62, P < 0.02). CONCLUSIONS: Intensive CIT, when combined with CBG measurements, can be used to rapidly improve glycemic control in type II diabetes without development of unacceptable hypoglycemia. This degree of metabolic improvement, however, requires large doses of exogenous insulin to overcome peripheral insulin resistance and results in greater hyperinsulinemia with progressive weight gain.

Algorithms↗

PubMed1993

Primary caffeine dependence: a case report.

We present a case of primary caffeine dependence based on the exclusive use of over-the-counter caffeine tablets. Caffeine has recently undergone scrutiny as a co-morbid risk factor with other substance dependencies, and in other medical and psychiatric conditions. Caffeine withdrawal also is briefly discussed with attention given to personality factors and the use of nicotine. Although caffeine generally is considered safe in usual doses, it is a substance potentially able to result in serious dependence. We cite a case which also illustrates that a supportive inpatient milieu may be necessary in order to interrupt a cycle of heavy caffeine use resulting in marked dependence.

Adult↗