662 results on '"Mulsant BH"'
Search Results
652. Schizophrenia in late life: elderly patients admitted to an acute care psychiatric hospital.
- Author
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Mulsant BH, Stergiou A, Keshavan MS, Sweet RA, Rifai AH, Pasternak R, and Zubenko GS
- Subjects
- Aged, Alzheimer Disease diagnosis, Alzheimer Disease psychology, Atrophy, Brain pathology, Brain Damage, Chronic diagnosis, Brain Damage, Chronic psychology, Dementia psychology, Depressive Disorder diagnosis, Depressive Disorder psychology, Diagnosis, Differential, Disability Evaluation, Electroencephalography, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Psychiatric Status Rating Scales, Dementia diagnosis, Patient Admission, Schizophrenia diagnosis, Schizophrenic Psychology
- Abstract
Although a considerable body of biological and clinical data has been accumulated on the mood disorders and organic disorders of late life, only a handful of studies have focused on aging schizophrenia patients. Using the results of a comprehensive evaluation of all elderly patients admitted over a 30-month period to a 26-bed acute care geriatric unit, we compared the demographic, social, and clinical characteristics of schizophrenia patients, patients with recurrent major depression with and without psychotic features, and patients with primary degenerative dementia of the Alzheimer's type with and without delusions. The main findings of this study are that elderly schizophrenia patients were younger, more often African-American, more often single, and poorer than the other groups. A concomitant history of substance abuse and institutionalization as an outcome were more frequent among schizophrenia patients. Like the older depressed and demented patients, schizophrenia patients were predominantly female and commonly presented with several medical disorders. The potential significance of these findings is discussed in the context of the literature on the long-term outcome of schizophrenia.
- Published
- 1993
- Full Text
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653. Personality Disorders in Elderly Inpatients With Major Depression.
- Author
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Kunik ME, Mulsant BH, Rifai AH, Sweet R, Pasternak R, Rosen J, and Zubenko GS
- Abstract
We studied 154 patients with major depression, with and without personality disorder (PD), consecutively admitted to a geriatric unit and compared their characteristics and responses to acute inpatient treatment. Thirty-seven patients (24%) met DSM-III-R criteria for PD. PD not otherwise specified and dependent PD were the most frequent PD diagnoses, whereas dramatic cluster PDs were rare. Patients with PD were significantly more likely to have had 1) recurrent depression, 2) an earlier age at first episode, and 3) a concurrent anxiety disorder. There was a higher proportion of patients with PD to have 1) never married, 2) separated or divorced, or 3) attempted suicide. During inpatient stays of similar lengths, both groups received similar treatment and improved to a similar and significant extent., (Copyright © 1993 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)
- Published
- 1993
- Full Text
- View/download PDF
654. Nortriptyline in the hospitalized elderly: tolerance and side effect reduction.
- Author
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Rosen J, Sweet R, Pollock BG, and Mulsant BH
- Subjects
- Bethanechol Compounds adverse effects, Bethanechol Compounds therapeutic use, Depressive Disorder psychology, Double-Blind Method, Drug Tolerance, Female, Humans, Male, Nortriptyline adverse effects, Aged psychology, Depressive Disorder drug therapy, Nortriptyline therapeutic use
- Abstract
This article describes two separate but related studies regarding the use of nortriptyline (NT) in the treatment of depressed elderly inpatients. The first study assesses medication tolerance to NT during the acute treatment of late-life depression. The second describes a placebo-controlled study of the effect of bethanechol in reducing antimuscarinic side effects of NT. Antidepressant pharmacotherapy was considered for 72 patients with late-life depression; 17 (24%) did not receive NT; 5 (7%) because of absolute or relative medical contraindications. Of the 55 patients who started on NT, 9 percent had side effects that necessitated medication discontinuation. A separate sample of 26 elderly depressed patients being treated with NT participated in a double-blind, placebo-controlled trial of bethanechol. Patients receiving bethanechol had reduced subjective complaints of anticholinergic side effects and showed improvement on an objective measure of salivary flow.
- Published
- 1993
655. Impact of psychiatric hospitalization on behavioral complications of Alzheimer's disease.
- Author
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Zubenko GS, Rosen J, Sweet RA, Mulsant BH, and Rifai AH
- Subjects
- Aged, Alzheimer Disease classification, Alzheimer Disease therapy, Antipsychotic Agents therapeutic use, Behavior Therapy, Cognition Disorders diagnosis, Cognition Disorders therapy, Delirium diagnosis, Delirium therapy, Delusions diagnosis, Delusions therapy, Depressive Disorder diagnosis, Depressive Disorder therapy, Female, Frail Elderly psychology, Humans, Institutionalization, Male, Mental Disorders therapy, Prognosis, Prospective Studies, Psychiatric Status Rating Scales, Psychotherapy, Severity of Illness Index, Alzheimer Disease diagnosis, Hospitalization, Mental Disorders diagnosis
- Abstract
Objective: The authors conducted a prospective study of the clinical utility of the four DSM-III-R subtypes of primary degenerative dementia of the Alzheimer type (with delirium, with delusions, with depression, or uncomplicated) and acute psychiatric hospitalization for treatment of these subtypes., Method: The subjects were 120 consecutive inpatients with Alzheimer's disease, most of whom had behavioral abnormalities. Each subject received detailed physical, neurological, psychiatric, and mental status examinations. The presence or absence of specific behavioral problems was also documented. Patients were treated with medication, psychotherapy, and behavioral techniques., Results: While all patients could be assigned to one of the four DSM-III-R behavioral subtypes, the uncomplicated subtype did not accurately reflect the burden of behavioral symptoms in the patients who did not have delirium, delusions, or depression. Each behavioral subtype responded in a characteristic way to inpatient treatment, as reflected by changes in scores on four psychometric scales used to assess cognitive impairment, psychiatric symptoms severity, and level of functioning at admission and at discharge, as well as by changes in residential setting following hospitalization. Half of all patients admitted from their homes and two-thirds of those with depression were able to go home following discharge., Conclusions: Behavioral syndromes in Alzheimer's disease should not be overlooked, because they have both clinical and prognostic significance. Short-term psychiatric hospitalization is effective and efficient for achieving the goal of returning patients to their homes and for safely implementing specific treatments in this frail population, and it may reduce the need for institutionalization.
- Published
- 1992
- Full Text
- View/download PDF
656. Dyskinesia and neuroleptic exposure in elderly psychiatric inpatients.
- Author
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Sweet RA, Mulsant BH, Rifai AH, and Zubenko GS
- Subjects
- Aged, Antipsychotic Agents therapeutic use, Atrophy, Cerebral Cortex pathology, Dementia psychology, Dyskinesia, Drug-Induced diagnosis, Female, Humans, Male, Neurologic Examination, Psychotic Disorders psychology, Risk Factors, Antipsychotic Agents adverse effects, Dementia drug therapy, Dyskinesia, Drug-Induced etiology, Hospitalization, Psychotic Disorders drug therapy
- Abstract
A wide variation in prevalence rates of tardive dyskinesia and spontaneous orofacial dyskinesia has been reported in the elderly. To clarify these discrepancies, we studied 45 patients over the age of 60 years admitted to a short-term psychiatric unit. Standardized criteria for the diagnosis of dyskinesia were used. We found a rate of tardive dyskinesia of only 21% (7/33) in our patients having a history of neuroleptic exposure. We found no cases (0/12) of spontaneous orofacial dyskinesia. There was a significant association between tardive dyskinesia and psychiatric diagnosis, with the highest rate of tardive dyskinesia in those patients with schizophrenic disorders, followed by those with organic disorders and mood disorders, respectively. There was also a significant association between the presence of tardive dyskinesia and radiographic evidence of cortical atrophy, and a trend towards an association with leukoencephalopathy. Our results suggest that published rates of tardive and spontaneous dyskinesia in the elderly may overestimate the prevalence of these disorders, especially among geriatric patients with acute psychiatric presentations.
- Published
- 1992
- Full Text
- View/download PDF
657. Relation of age to prevalence of tardive dyskinesia.
- Author
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Sweet RA, Mulsant BH, Rifai AH, and Zubenko GS
- Subjects
- Age Factors, Aged, Aged, 80 and over, Humans, Middle Aged, Prevalence, Dyskinesia, Drug-Induced epidemiology
- Published
- 1992
- Full Text
- View/download PDF
658. A prospective naturalistic study of electroconvulsive therapy in late-life depression.
- Author
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Mulsant BH, Rosen J, Thornton JE, and Zubenko GS
- Subjects
- Aged, Aged, 80 and over, Confusion etiology, Depressive Disorder psychology, Electroconvulsive Therapy adverse effects, Female, Humans, Male, Mental Status Schedule statistics & numerical data, Middle Aged, Prospective Studies, Psychiatric Status Rating Scales statistics & numerical data, Psychometrics, Risk Factors, Depressive Disorder therapy, Electroconvulsive Therapy methods
- Abstract
We performed a prospective, naturalistic study using standardized clinical rating scales to characterize the effect of electroconvulsive therapy (ECT) on mood, cognition, and medical status in late-life depression. Over a 16-month period, 40 patients aged 60 years and over who fulfilled DSM-III criteria for a major depressive episode received a total of 42 ECT courses. Three patients (7%) developed significant medical complications: one had a syncopal episode due to arrhythmia, and two had symptomatic vertebral compression fractures. Confusion was noted during 13 courses (31%) and persisted at discharge in four (10%). More than half the patients were either psychotic or demented on admission, and all but three had been either unresponsive or intolerant to pharmacotherapy. All patients experienced a decrease in their depressive symptoms and more than two thirds were in complete or partial remission at discharge. Patients with psychotic depression experienced a greater improvement than patients with nonpsychotic depression, and patients with organic mental disorders experienced the same improvement as other patients. This study confirms that ECT is a safe and effective treatment of depression in late life.
- Published
- 1991
- Full Text
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659. A Retrospective Study of Maintenance Electroconvulsive Therapy in a University-Based Psychiatric Practice.
- Author
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Thornton JE, Mulsant BH, Dealy R, and Reynolds CF 3rd
- Abstract
We reviewed the log book of our university-based electroconvulsive therapy (ECT) service for the years 1981 to 1987. We identified 10 patients treated with monthly maintenance electroconvulsive therapy (ECT-M). These 10 patients received 3% of the ECT treatments given in this 7 year period. The review of their charts suggests that ECT-M is generally reserved for patients who are older (i.e., over 60 years of age), suffering from delusional depression and/or depressive pseudodementia, and have a history of poor response or tolerance to medications but good response to ECT. The patients had fewer hospitalizations in the 18 months after initiating ECT-M than during the 18 months preceding ECT-M (mean of 3.1 vs. 0.3, respectively, p < 0.001). However, this apparent efficacy of ECT-M may be confounded by the concurrent use of medication. A review of the literature reveals only descriptive studies on ECT-M and shows that our data are congruent with these published studies. The relative value of maintenance ECT and its specificity remain unknown. Its apparent impact on hospitalization rates and safety warrant controlled trials.
- Published
- 1990
660. A neural network as an approach to clinical diagnosis.
- Author
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Mulsant BH
- Subjects
- Computer Communication Networks, Dementia diagnosis, Expert Systems, Humans, Software, Artificial Intelligence, Diagnosis, Computer-Assisted
- Abstract
During the past decade, artificial neural networks have been established as promising psychological and computational models. The proponents of neural computing believe that it offers new solutions to problems that have been intractable so far. To study the suitability of neural networks for performing sequential diagnostic classification, I have used a network that, over time, becomes increasingly proficient at diagnosing dementia. A description of the implementation, training, and behavior of this network illustrates how neural-network technology might contribute to clinical computing.
- Published
- 1990
661. Adverse reactions to antihypertensive drugs.
- Author
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Flegel KM, Hutchinson TA, Mulsant BH, and Kramer MS
- Subjects
- Humans, Prospective Studies, Antihypertensive Agents adverse effects
- Published
- 1987
662. HIV infection presenting as psychosis: a critique.
- Author
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Vogel-Scibilia SE, Mulsant BH, and Keshavan MS
- Subjects
- Adult, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Acquired Immunodeficiency Syndrome diagnosis, Psychotic Disorders diagnosis
- Abstract
A review of the literature on HIV and psychiatry thus far has revealed 13 cases of HIV infection presenting as psychosis. We argue that these cases could in fact represent either coincidental schizophrenia or bipolar disorder and HIV infection or HIV-related organic hallucinosis, delusional or affective syndromes with or without associated dementia (AIDS-dementia complex). The use of the term psychosis in describing AIDS-related behavioral syndromes is misleading, and should be replaced when possible by specific DSM-III-R categories.
- Published
- 1988
- Full Text
- View/download PDF
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