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1.  Delirium episodes during the course of clinically diagnosed Alzheimer's disease. 
A retrospective review was conducted of 122 charts of patients with clinically diagnosed Alzheimer's disease (CDAD) who had participated in a longitudinal dementia study at the Mayo Clinic from 1965 to 1970. DSM-III-R diagnoses were assigned based on the longitudinal description of symptoms detailed in the Mayo Clinic medical records of the hospitalizations; clinic, home, and nursing home visits; and state hospital admissions. Thirty patients (25%) were found to have a delirium episode during their course of CDAD that occurred during inpatient admissions; 50% (15 of 30) of the delirium episode occurred in patients ages 80 to 89. Among patients with a delirium episode, 50% died within one year of the delirium episode and 64% died within two years. Of 13 patients, 10 (77%) had multiple delirium episodes within two years. Admitting diagnoses were mainly primary degenerative dementia of the Alzheimer's type (PDDAT) or PDDAT with delirium. Only 3 (10%) demented patients experienced delirium episodes during a medical admission. No deaths occurred during hospitalization for the years covered by this study. A psychiatric consultation was requested in only 17 (14%) patients; 88% of these patients received diagnoses involving PDDAT, late onset. An additional diagnosis included depressive disorders. Psychopharmacology was the major management strategy (82% of patients with a delirium episode received medication) with a resolution of symptoms within 48 hours. At discharge, only 2 (7%) patients failed to clear the increased degree of confusion.
PMCID: PMC2608571  PMID: 10641498
3.  Comparison of blood pressure between Indiana AMA and NMA members. 
OBJECTIVE: 1) To determine whether African-American physicians, compared to caucasian physicians, were at increased risk to develop hypertension; and 2) to determine whether physicians' knowledge of cardiovascular risk factors influenced their pattern of exercise. DESIGN: A mailed survey of members of the American Medical Association (AMA) and the National Medical Association (NMA) was completed to assess health status and plans for retirement. RESULTS: High-normal blood pressure was defined as systolic blood pressure of 85-89 mmHg. Mild (stage-1) hypertension was defined as systolic blood pressure of 140-159 mmHg and diastolic blood pressure of 90-99 mmHg. Gender (male), age, and body mass index (BMI) were significantly correlated with elevated levels of selected blood pressure measures. Using regression analysis to control for gender, age, and BMI, ethnicity was identified as a fourth factor accounting for elevated blood pressure. NMA physicians had 3.25 times the risk of having systolic blood pressure in the mild (stage-1) hypertension range, 5.78 times the risk for blood pressure in the high-normal diastolic hypertension range, and 5.19 times the risk for blood pressure in the mild (stage-1) diastolic hypertension range. Medical specialty and type of psychological support were not significant predictors of elevated blood pressure. CONCLUSION: These data suggest that African-American physicians may be at an increased risk to develop abnormal blood pressure, compared to caucasian physicians, potentially affecting the number of physicians available to minority communities.
PMCID: PMC2594674  PMID: 14651369
4.  The Evaluation of Elderly Patients by a Psychiatric Emergency Service 
A retrospective descriptive study of older patients evaluated by the psychiatric emergency service (PES) of a general hospital was implemented. The medical records of all patients aged 65 years and older evaluated by the PES during the 1980 calendar year were reviewed. Seventy-four patients were identified, 38 male and 36 female. Forty-three percent of the sample had no medical problems, 59 percent had a prior psychiatric history, and 38 percent had a diagnosis of organic brain syndrome. After their evaluation, 43 percent of these older patients were discharged home with a referral for outpatient treatment. In contrast to prior studies, only 35 percent of the sample were taking two or more psychoactive medications. Only two patients were referred for evaluation from skilled nursing homes.
PMCID: PMC2625790  PMID: 3404560
5.  Geriatric Psychiatry: A Model for Evaluation 
An overview of psychiatric disorders seen in older patients is reviewed. Dementing illnesses are discussed. A specific method of assessing the patient with cognitive decline in a clear sensorium is presented.
PMCID: PMC2571273  PMID: 3712470
6.  Association between reported education and intellectual functioning in an ethnically diverse adult psychiatric inpatient sample. 
Patients' pre-existing survival skills, educational attainment, and intellectual functioning should be included in the development and implementation of treatment planning for adult psychiatric inpatients. When considering culturally diverse inpatient populations with possible cultural and language barriers, these variables may attain additional importance. Utilizing a sample (N = 60) primarily consisting of Asian/Pacific Islander inpatients, the present study investigated: (a) the rate at which professionals from different disciplines inquired about educational attainment; (b) the association between self-reported education and standardized measures of intelligence; and (c) the correspondence between different IQ scores. Axis 1 diagnoses included schizophrenia (N = 19; 32%), schizoaffective disorder or bipolar disorder (N = 23; 38%), and organic or substance-related disorders (N = 18; 30%). Thirty-five percent of the sample (N = 21) had dual diagnoses. The results indicated that only psychologists who administered IQ tests consistently inquired about educational attainment. An expected overall positive association between self-reported education and standardized intelligence measures was found. High correlations between the Test of Nonverbal Intelligence, 2nd edition (TONI-2) and Wechsler Adult Intelligence Test-Revised (WAISQ-R) IQs suggested that both tests were valid in the assessment of intellectual functioning. Implications included the need for more systematic assessment and incorporation of pre-existing skill-based information and the utility of self-reported education and different measures of intellectual functioning (including TONI-2).
PMCID: PMC2594083  PMID: 11837353
7.  Black, middle-class women in San Antonio, Texas. 
Fifty-six African-American women between the ages of 20 and 84 who had completed a minimum of 4 years of college and were employed in professional positions (eg, teacher, technician, lawyer, and physician) were identified in San Antonio, Texas. Specific information concerning marital status, income, home ownership, family of origin, presence of professional siblings, husbands' characteristics, medical and psychiatric health, and significant influences in their lives were obtained by a semistructured interview. This article summarizes the results of these interviews and presents the techniques used to identify this sample of African-American, middle-class women.
PMCID: PMC2637738  PMID: 1608061
8.  A contrast: geriatric depression versus depression in younger age groups. 
A major depressive illness can occur at any stage of the life cycle. This article discusses the various presentations of depressive illness in older persons and contrasts these disorders with other age groups. A mnemonic based on the word "depression" provides a summary of several causes of depressive illness. The discussion concludes with a few comments on the diagnosis and screening for depression.
PMCID: PMC2627062  PMID: 1920507
9.  Black youth suicide: literature review with a focus on prevention. 
The national rates of completed suicide in the black population between 1950 and 1981 are presented, including age-adjusted rates. Specific studies of black suicide attempters and completed suicides by blacks in several cities are discussed. Methodological problems with existing studies and national suicide statistics are presented. Proposed theories of black suicide are reviewed. Based on a summary of the characteristics of black suicide attempters reported by the literature, preventive strategies--primary, secondary, and tertiary--are presented.
PMCID: PMC2626959  PMID: 2204709
10.  Suicide Attempters in New Haven: A Ten-Year Perspective 
A retrospective, descriptive study of 294 suicide attempters evaluated by a general hospital's psychiatric service was completed by chart review. The 1980 sample differed from prior studies of this setting. Seventy-one percent of attempters had a prior psychiatric history, 31 percent were psychotic, and 25 percent had a diagnosis of substance abuse (combining alcohol and drug abuse). Overdose remained the predominant method of attempt, with a significant increase (P < .001) in the use of psychoactive medication. The ratio of the rates of male to female suicide attempters had increased to .8191. The crude suicide attempt rate for the New Haven Standard Metropolitan Statistical Area (SMSA) had declined to 191.32/100,000.
PMCID: PMC2625707  PMID: 3246702
11.  Consultation-Liaison Activities With Geriatric Patients 
With the aging of our population, the number of persons aged 65 years and over referred to psychiatric consultation-liaison services is increasing. The author discusses a specific approach to such consultations and the specific concerns that they raise.
PMCID: PMC2625660  PMID: 3323539
12.  Competent for What? 
As the United States population ages, psychiatrists will have increasing requests for consultations to address legal issues involving older persons. Following an overview of competency as a distinct legal issue, specific legal issues are addressed that include hospitalization, consent or refusal of treatment, living will legislation, and guardianship and conservatorship. Relevant cases are cited.
PMCID: PMC2625549  PMID: 3625793
13.  The Afro-American Life Cycle: Success, Failure, and Mental Health 
The author examines the Afro-American life cycle from the period of the 1900s to the 1980s and discusses the psychosocial context for a three-generation Afro-American family living in America in the 1980s. The specific stresses and successful or maladaptive coping strategies of the members are presented as well as the potential mental health problems arising from ineffective mastery of developmental transitions.
PMCID: PMC2625537  PMID: 3302279
14.  Utilization of Mental Health Services by the Aging 
A descriptive study of persons 55 years of age and older who were newly admitted (60 cases) or in ongoing treatment (30 cases) in a mental health center was done as an outgrowth of a utilization review study. The total population of 461 was studied from July 1, 1977, to June 30, 1978. A chart review of 90 cases was performed. The newly admitted subsample was married, was diagnosed as depressed, and had a broad range of dispositions into various treatment modalities. The chronic subsample was single, diagnosed as schizophrenic, and in treatment in a single community-support unit. These differences were statistically significant at the P<.01, P<.001, and P<.001 levels, respectively. Although the newly admitted subsample had no previous contact with psychiatric services, 44 of the 60 patients (73 percent) were on psychoactive medication prescribed by nonpsychiatric physicians. Implications for the training of general medical practitioners and mental health center staff, and the need for ongoing assessment of patients in community support units are discussed, as well as the significant risk to patients from potentially harmful drug interactions.
PMCID: PMC2561764  PMID: 6737502
15.  Emergency Service Nursing Staff: A Survey of Knowledge, Attitudes, and Concerns 
A survey of the nursing staff in an emergency service was completed by anonymous questionnaire. The results of the survey indicate satisfaction and confidence in the triaging group, a wish for more staff and specific inservice course content, good perception of emergency situations, misperception about restraint policy and the life-threatening nature of opiate withdrawal, and the need to focus on a clearer definition of those patients who do not require acute care.
PMCID: PMC2561556  PMID: 6864820
16.  Compazine Complications: A Review 
Two patients with toxic reactions to prochlor-perazine (Compazine) prescribed as an antiemetic are presented. The authors caution against wrongfully labeling such patients as having psychiatric disturbances when the cause is iatrogenic.
PMCID: PMC2552666  PMID: 7014918
17.  An overview of depression in the elderly: a US perspective. 
This article is organized in seven sections. The first section presents a review of the existing epidemiologic data on the prevalence of depressive illness in different, elderly US populations (community residents versus the medically ill). Section two describes the US elderly population. Section three describes three presentations of depression in the elderly. Section four addresses the outcome of depressive disorder untreated or partially treated. In section five the data on suicide in the elderly is reviewed. An overview of specific considerations for the psychopharmacologic and psychotherapeutic treatment of depression is presented in section six. Section seven provides a summary of the major points of the article.
PMCID: PMC2608038  PMID: 8839033
18.  Misdiagnosis among older psychiatric patients. 
The first 13 consecutive referrals to a newly established Geriatric Psychiatry Research Division (GPRD) at a community mental health center (CMHC) in Baltimore, Maryland, were evaluated with the structured clinical interview (SCID) from the third edition of the Diagnostic and Statistical Manual, Revised (DSM-III-R). Although the referring primary diagnoses were confirmed in 54% of patients (7 of 13), an average of three new diagnoses were made for each patient that had not been considered. Of the remaining six patients, four (67%) patients with a diagnosis of schizophrenia were found to have a diagnosis of affective disorder based on the SCID interview (two patients with bipolar disorder, depressed and two patients with schizoaffective disorder, depressed). In the remaining two (33%) patients, one patient had a diagnosis of mixed dementia due to longstanding alcohol abuse with a superimposed primary degenerative dementia of the Alzheimer's type. The remaining patient's initial diagnosis of dementia associated with alcoholism was changed to bipolar disorder, depressed. These results provide support for the hypothesis that older persons with psychiatric illness may have been misdiagnosed at a time of less diagnostic rigor.
PMCID: PMC2607975  PMID: 8558619
19.  Cocaine psychosis. 
A 28-year-old divorced black male intranasal cocaine abuser presented three times in seven days to the psychiatric emergency service of a general hospital with complaints of psychotic symptoms in the context of a cocaine binge. His repeated visits provided the opportunity to correlate his clinical picture with serum cocaine levels. This article describes that correlation and reviews the current literature on cocaine abuse and the cocaine abstinence syndrome.
PMCID: PMC2626061  PMID: 2674466

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