James Kelly Moles

Increasing the clinical yield of computerized tomography for psychiatric patients

Computerized tomography (CT) continues to be extensively utilized to exclude intracranial pathology in psychiatric practice, but little is known about clinical risk factors, which might predict those patients most likely to benefit from the procedure. We reviewed 150 cases of psychiatric patients who received CT scans to exclude intracranial pathology. We assessed the relationships of patient age, psychiatric diagnosis, and findings from neurologic and cognitive examinations to CT results that influenced patient care, and overall normal and abnormal CT results. Fifty-three percent of the CT scans were abnormal, 11% influenced patient care, and only 2% identified potentially reversible lesions. Cognitive exam results and, to a lesser extent, neurologic exam results, were sensitive predictors of CT findings that influenced patient care. All patients with clinically influential CT results had cognitive deficits and all but one had neurologic deficits. Patients older than 60 years of age and those with organic mental syndromes were most likely to have clinically influential CT findings. Our results suggest that utilizing specific clinical risk factors such as findings from clinical examinations, patient age, and psychiatric diagnosis, to guide the ordering of CT scans, can greatly increase the yield of the procedure for psychiatric patients, without excess medical morbidity.

Reemergence of tardive dyskinesia after discontinuation of clozapine treatment

Tardive dyskinesia (TD) continues to be a significant health problem and a serious limitation to neuroleptic medication treatment. Clozapine treatment may reduce the severity of TD but it is unclear wether the medication temporarily suppresses symptoms or leads to a sustain resolution of the disorder. Herein we describe two cases with severe TD which clozapine had to be discontinued. These cases suggest that clozapine provides a temporary suppression of TD rather than a permanent resolution of the disorder.

Selective serotonin reuptake inhibitors for aggressive behavior in patients with dementia after head injury

Head injury of any severity can result in acute and chronic neuropsychiatric symptoms. After head injury, aggressive behaviors can be disabling to victims and stressful to their families. When aggression is compounded by dementia, treatment can be more difficult. Psychotropic agents can attenuate aggressive behaviors associated with mental disorders. Three patients with dementia and chronic aggression after head injury responded favorably to selective serotonin reuptake inhibitors.

Hepatitis C screening in patients attending substance abuse treatment programs

Purpose: There is a mounting body of evidence to suggest that patients with past and present diagnoses of alcohol dependence and non-intravenous (IV) drug dependence are at an increased risk for Hepatitis C virus (HCV) infection. Very little is known about the association between HCV status and substance abuse treatment outcomes in these patients.

Hepatitis C and post-traumtic stress disorder in US veterans

Purpose: Post-traumatic stress disorder (PTSD); an anxiety disorder marked by an impairment in the immunological response, and Hepatitis C virus (HCV) infection are more prevalent in the US veteran population. To esatblish the interplay of these two chronic debilitating conditions we assessed the prevalence of HCV infection in veterans with PTSD, as well as the prevalence of PTSD in veterans with HCV. Treatment outcomes of HCV and PTSD in a small sample were tracked.