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Biomedical subjects

W Clay Jackson

Publications and source records attributed to W Clay Jackson.

10 recordsLinked to original sources
PubMed2005

Sustained remission with lamotrigine augmentation or monotherapy in female resistant depressives with mixed cyclothymic-dysthymic temperament.

BACKGROUND: The treatment of bipolar depression remains problematic. Lamotrigine has been shown in randomized controlled studies to be efficacious in preventing bipolar depression and rapid cycling states. METHODS: Twenty-four women with cyclothymic temperament and refractory depression were recruited from four outpatient sites (three primary care and one psychiatric) and treated with lamotrigine in a naturalistic, open-label study. Temperament was determined by responses on the TEMP-A self-rating scale. Eighteen (75%) of these cyclothymic patients also scored high on the depressive temperament. Eighteen (75%) met DSM-IV criteria for bipolar II disorder. In two thirds of the cases, lamotrigine was add-on therapy to an antidepressant. Response to therapy was assessed using the DSM-IV Global Assessment of Functioning (GAF). LIMITATIONS: This study was naturalistic in design, without controls or blinds. RESULTS: Of the 23 patients who remained in the study, 16 (70%) had significant, sustained responses. Of these 16, 12 (75% of responders, 52% of the total) had remissions (GAF > 80) sustained longer than 12 months. Robust, sustained responses to lamotrigine monotherapy were seen in 4 patients (17%). Seven patients (30%) received no apparent benefit from lamotrigine. CONCLUSIONS: Lamotrigine induced prolonged illness remissions in a substantial number of female patients whose symptoms were both complex and refractory. Most manifested high scores on the cyclothymic and depressive temperaments, and prior refractoriness to multiple antidepressant and antidepressant/mood stabilizer combinations, before remitting with lamotrigine augmentation or monotherapy.

Adult↗
PubMed2004

Retrospective Study of Olanzapine in Depressive and Anxious States in Primary Care.

CONTEXT: Bipolar spectrum and treatment-resistant unipolar mood disorders are increasingly identified in primary care settings. Olanzapine demonstrates efficacy in the treatment of acute mania and bipolar depression and in bipolar maintenance therapy. Olanzapine-fluoxetine combination therapy shows efficacy in treatment-resistant depression. OBJECTIVE: To examine the efficacy and tolerability profile of olanzapine in various difficult-to-treat depressive and/or anxious states in primary care outpatients. METHOD: A retrospective chart review was conducted for all identifiable patients prescribed olanzapine for mood disorders (DSM-IV) during a 3-year period (July 1998-July 2001), utilizing clinician and nurse recall, sampling of general continuity clinic records, and a hand search of mood disorder clinic records. MAIN AND SECONDARY OUTCOME MEASURES: Initial and final scores on the Global Assessment of Functioning (GAF) scale, duration of therapy, and adverse effects. RESULTS: Thirty-seven patients were identified as having received treatment with olanzapine; 3 were referred to the mental health specialty sector at the time of treatment initiation, and 2 were lost to follow-up. Of the 32 patients receiving ongoing treatment by primary care clinicians, most were female (N = 23; 72%) and all were white (100%). Most were diagnosed with a mental illness in the bipolar spectrum (N = 25; 78%) and demonstrated treatment resistance with antidepressants and/or mood stabilizers (mean number of previous psychotropic medications = 3.7). In the group completing therapy (24 patients [75%]; mean duration of treatment = 242 days), GAF scores demonstrated a clinically and statistically significant improvement (mean initial GAF score = 59 +/- 9; mean final GAF score = 76 +/- 11; p < .0001). Twenty (83%) of these 24 patients demonstrated sustained improvement in their GAF scores. In the group that discontinued therapy (8 patients [25%]; mean duration of treatment = 123 days), GAF scores also demonstrated a clinically and statistically significant improvement (mean initial GAF score = 51 +/- 15; mean final GAF score = 70 +/- 11; p < .0001). Six (75%) of these 8 patients demonstrated sustained improvement in their GAF scores. For all patients, observed adverse effects included weight gain (25 patients [86%]; mean = 3.63 kg), sedation (6 patients [19%]), and dry mouth (1 patient [3%]). CONCLUSION: Olanzapine shows promise as an effective pharmacotherapeutic agent for primary care patients with mood disorders that lie along the bipolar spectrum or that are resistant to treatment with antidepressant monotherapies, but is associated with mild-to-moderate weight gain.

Journal Article↗
PubMed2003

Olanzapine for intractable nausea in palliative care patients.

Nausea is a common problem among palliative care patients, which is often undertreated. Olanzapine, an atypical antipsychotic, possesses a unique neurotransmitter binding profile that is similar to methotrimeprazine, an anti-emetic widely used in Europe for recalcitrant nausea. We report a case series of six patients who suffered nausea which was resistant to initial treatment with traditional antiemetics; each patient exhibited marked improvement when treated with olanzapine.

Aged↗
PubMed2002

When Patients Are Normal People: Strategies for Managing Dual Relationships.

A significant number of generalist physicians, particularly those in rural areas, often find themselves participating in the care of patients for whom the therapeutic relationship overlaps with another relationship (e.g., social or professional). Although psychiatrists and psychologists are typically advised to avoid such "dual relationships," no such prohibition exists for generalists. Little, if any, guidance exists to aid in the management of such dual relationships for the generalist who provides treatment for psychiatric conditions for his or her patients. The author, a generalist with experience in the treatment of mood disorders, describes potential challenges faced by the generalist who chooses to provide care for "dual relationship" patients and outlines strategies for successfully meeting these challenges.

Journal Article↗
PubMed1999

When All Else Is Done: The Challenge of Improving Antemortem Care.

Recent findings from the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) reveal that Americans are receiving antemortem care that is highly technical and interventional, but poorly consistent with patients' wishes. A growing body of research in palliative medicine describes a manner of care that restores the possibility of a "good death" to the vast majority of patients. By familiarizing themselves with the medical, psychological, legal, and existential aspects of antemortem care, primary care physicians can offer excellent palliative care, changing the landscape of postmodern medicine for the benefit of all patients-including ourselves.

Journal Article↗
PubMedDate not supplied

Antemortem care in an afternoon: a successful four-hour curriculum for third-year medical students.

Numerous well-designed studies have shown that patients near the end of life often receive substandard palliative care. Medical students have expressed a strong interest in antemortem care; however, palliative medicine education remains poorly integrated into the overall curriculum at most medical institutions in the United States. In response to this need, a palliative medicine curriculum has been developed for medical students in the required third-year clerkship in family medicine at the University of Tennessee Health Sciences Center The implementation of this curriculum resulted in a statistically significant increase in student competence (as measured by a standardized pretest and post-test) and a significant trend in student confidence (as measured by a single-item Likert scale). The curriculum was popular with students, and encouraged many of them to request hospice clinical experiences during their family medicine clerkship, or to register for the elective fourth-year clerkship in palliative medicine.

Clinical Clerkship↗
PubMedDate not supplied

Our best path forward.

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Confidentiality↗