Norman L. Keltner

Biological Perspectives: Mechanisms and Treatments of SSRI-Induced Sexual Dysfunction

SSRI-induced sexual dysfunction affects 30% to 50% or more of individuals who take these drugs for depression. Biochemical mechanisms suggested as causative include increased serotonin, particularly affecting 5HT2 and 5HT3 receptors; decreased dopamine; blockade of cholinergic and alpha-1 adrenergic receptors; inhibition of nitric oxide synthetase; and elevation of prolactin levels. Five approaches to treatment include conservative approaches such as wait and see, decrease dosage, and drug holidays. More aggressive strategy for treating SSRI-induced sexual dysfunction are changing antidepressants and augmentation.

Tacrine: A Pharmacological Approach to Alzheimer's Disease

Overall, studies of the effect of tacrine on the cognitive symptoms of AD are inconclusive. Small (1992) gave some insight into this variability of results by stressing that different research methods can generate different outcomes. Small also pointed out that there is an inherent weakness in the Mini Mental State Examination (MMSE)--a tool used in most, if not all, AD studies. The MMSE is not sensitive to subtle and real changes in mental function. Regardless of the inconclusiveness of these studies, research must continue in order to tease out the variables contributing to clinically significant gains found in some studies. Anecdotal observations, combined with the previously summarized clinical trials, indicate that a subgroup of AD patients may hope to benefit from tacrine. At a geriatric clinic with which the author is associated, prospective patients and their families are told that tacrine helps about 10% to 20% of those who take it. Further, they are instructed that tacrine seems to be most helpful if given early in the disease process and that it is relatively expensive. Treatment with tacrine costs about

Does caregiver well-being predict stroke survivor depressive symptoms? A mediation analysis

1,000 to

Assessing and treating forgetfulness and cognitive problems in adults with HIV.

1,500 per year (Anderson, 1993). The maximum dose of tacrine is 120 mg per day, and there is a relatively high incidence of side effects. The most serious side effect of tacrine is liver toxicity, which occurs in up to 30% of the patients taking this drug. Elevations in serum aminotransferase levels occur with the same frequency and therefore must be closely monitored. Additionally, 20% of patients taking tacrine develop nausea and vomiting.(ABSTRACT TRUNCATED AT 250 WORDS)

Are Neuroleptic Malignant Syndrome and Serotonin Syndrome the Same Syndrome

Abstract Background and Purpose: Studies suggest that family caregiver well-being (ie, depressive symptoms and life satisfaction) may affect stroke survivor depressive symptoms. We used mediation analysis to assess whether caregiver well-being might be a factor explaining stroke survivor depressive symptoms, after controlling for demographic factors and stroke survivor impairments and problems. Methods: Caregiver/stroke participant dyads (N = 146) completed measures of stroke survivor impairments and problems and depressive symptoms and caregiver depressive symptoms and life satisfaction. Mediation analysis was used to examine whether caregiver well-being mediated the relationship between stroke survivor impairments and problems and stroke survivor depressive symptoms. Results: As expected, more stroke survivor problems and impairments were associated with higher levels of stroke survivor depressive symptoms (P < .0001). After controlling for demographic factors, we found that this relationship was partially mediated by caregiver life satisfaction (29.29%) and caregiver depressive symptoms (32.95%). Although these measures combined to account for 40.50% of the relationship between survivor problems and impairments and depressive symptoms, the direct effect remained significant. Conclusions: Findings indicate that stroke survivor impairments and problems may affect family caregivers and stroke survivors and a high level of caregiver distress may result in poorer outcomes for stroke survivors. Results highlight the likely importance of intervening with both stroke survivors and family caregivers to optimize recovery after stroke.

Comparing the effectiveness of video-assisted oral debriefing and oral debriefing alone on behaviors by undergraduate nursing students during high-fidelity simulation

&NA; In addition to the immune system, HIV affects the nervous system and the brain, producing neurological sequelae, often resulting in forgetfulness and cognitive problems. These problems can compromise medication adherence, interfere with instrumental activities of daily living such as driving and managing finances, increase dependency, and decrease quality of life. Cognitive problems emerge due to a variety of reasons; likewise, several evidence‐based methods to mitigate causes and compensate for cognitive problems can be used alone or in combination. This article focuses on nonpathological, nondementia forgetfulness and cognitive problems. However, dementia must be considered and assessed as measured by marked cognitive decline over time. Methods for assessing and measuring forgetfulness and cognitive problems are provided. In addition, methods of treating nonpathological cognitive problems are provided, ranging from Recommended for Practice to Not Recommended for Practice. A case study is presented to demonstrate how to implement recommended treatment options.

Traumatic Brain Injury in Operation Enduring Freedom/Operation Iraqi Freedom: A Primer

The title question is interesting to contemplate. The basic elements of these two syndromes are similar, and some researchers believe them to “. . . exist on a spectrum of the same disorder” (Demirkiran, Jankovic, & Dean, 1986; Fink, 1996; Nisijima, Shioda, & Iwamura, 2007). Obviously, neuroleptic malignant syndrome (NMS) is caused by antipsychotic and other dopamine-compromising drugs, while serotonin syndrome (SS) is caused primarily by antidepressant and other serotonin-enhancing agents. Since the causative factor is dopamine hypofunction in the first and serotonin hyperfunction in the latter, it would seem NMS and SS are two different syndromes. However, when one reviews the mechanism of action of each, a convergence of effects seems to occur. For instance, atypical antipsychotics were marketed initially as serotonin/dopamine (5-HT2A/D2) antagonists. Why was the blockade of 5-HT2A so important that these drugs were heralded as second generation antipsychotics? The answer to that question is that by blocking serotonin 5-HT2A, these atypical antipsychotics are able to increase dopamine release in certain areas of the brain. It had been discovered that 5-HT2A receptors lay on the axonal terminal of dopaminergic neurons and that their stimulation by serotonin caused a decline in dopamine release. However, the antagonizing effect of these new antipsychotics prevented serotonin from diminishing the release of dopamine. This atypical mechanism enabled the circumvention of bedeviling side effects such as elevated prolactin, extrapyramidal side effects (EPSEs), and cognitive decline. Additionally, serotoninenhancing agents such as selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and other serotonin boosting drugs are known to cause EPSEs on occasion. The most likely chemical culprit for these extrapyramidal events is the stimulation of those same 5-HT2A receptors by increased intrasynaptic serotonin availability. The consequence of excessive serotonin stimulation of 5-HT2A on these dopaminergic neurons is a diminution of dopamine release from dopamine neurons. It may be then that symptoms associated with both NMS and SS are the effects of a final common pathway shared by both syndromes.

The Future of Cognitive Remediation Training in Older Adults

Complex healthcare, less resources, high-level medical equipment, and fewer available clinical settings have led many health professionals to use simulation as a method to further augment educational experiences for nursing students. While debriefing is recommended in the literature as a key component of simulation, the optimal format in which to conduct debriefing is unknown. This pre- and posttest two-group randomized quasi-experimental design compared the effectiveness of video-assisted oral debriefing (VAOD) and oral debriefing alone (ODA) on behaviors of 48 undergraduate nursing students during high-fidelity simulation. Further, this study examined whether roles (e.g., team leader, medication nurse), type of scenarios (i.e., pulmonary and cardiac scenarios), and student simulation team membership (i.e., VAOD and ODA groups) influenced these behaviors. Behaviors observed in this study related to patient safety, communication among team members, basic- and problem-focused assessment, prioritization of care, appropriate interventions, and delegation to healthcare team members. Both human patient simulator practice and guidance using video-assisted oral debriefing and oral debriefing alone appeared to be comparable regarding behaviors, regardless of roles, type of scenarios, and student simulation team membership. These findings suggest that nurse educators may use either video-assisted oral debriefing or oral debriefing alone to debrief undergraduate nursing students during high-fidelity simulation.

Biological perspectives: hydroxyzine for anxiety: another look at an old drug.

In greater numbers than in prior conflicts, service members deployed as part of Operation Enduring Freedom and Operation Iraqi Freedom have an increased risk of experiencing a traumatic brain injury (TBI). The basics of TBI are discussed, with particular attention paid to blast-related events, as this is a common mechanism of injury in this population. Particular attention is focused on the pharmacologic treatment of the sequlae of TBI and common comorbid conditions.

Reasons Why Persons Living With HIV Include Individuals in Their Chosen Families

ABSTRACT With the growing population of older adults, nurses will need to address age-related cognitive declines. Evidence demonstrates that cognitive remediation training is effective in improving neuropsychological abilities in older adults, which can translate into improved functioning in instrumental activities of daily living. The future of cognitive remediation training will incorporate health promoting factors (e.g., sleep hygiene, physical exercise), which supports neuroplasticity and cognitive reserve. By approaching cognitive health holistically, the patient will be primed to receive the maximum benefit from cognitive remediation training. A model emphasizing this approach is provided as a didactic for nurses and other health professionals providing care to their older patients.