Troy L. Thompson

Psychotropic Drug Use in the Elderly

ELDERLY persons (by definition, those 65 years of age and older) now make up about 11 per cent of the U.S. population, but about 30 per cent of all prescriptions are written for this group, primari...

Lack of Efficacy of Hydergine in Patients with Alzheimer's Disease

BACKGROUND There is no effective pharmacologic treatment for Alzheimers disease, the most common dementing illness in the United States. Hydergine, a combination of ergoloid mesylates, is the only approved medication for Alzheimers disease, but despite widespread use its efficacy remains to be established. We conducted a clinical trial of Hydergine-LC, a newer preparation of ergoloid mesylates in the form of a liquid in a capsule (LC) that may have greater bioavailability, to determine its value in patients with Alzheimers disease. METHODS AND RESULTS Eighty older adults with probable Alzheimers disease participated in this double-blind, placebo-controlled trial of Hydergine-LC for 24 weeks. The recommended dose of 1 mg orally three times daily was used. Cognition and behavior were evaluated before and after the trial, and the patients were monitored for adverse effects. The medication was safe and well tolerated. The Hydergine-LC group did not perform better after treatment than the placebo group on any test, and its performance was worse (P less than 0.01 and P less than 0.02, respectively) on one cognitive measure (Wechsler Adult Intelligence Scale Digit Symbol Substitution Task) and on one behavioral scale (the Geriatric Evaluation by Relatives Rating Instrument). CONCLUSIONS Hydergine-LC appears to be ineffective as a treatment for Alzheimers disease.

The Borderline Personality in the Medical Setting

Patients with a borderline personality disorder are notorious for causing problems in medical settings because of their angry, provocative, and often self-destructive behaviors. Such patients may frequently evoke negative, often angry responses in physicians. The diagnosis and effective management of such patients are discussed.

Underconsultation and lack of follow-up for alcohol abusers in a university hospital

Abstract In a prospective chart audit of university hospital medical inpatients, an alcohol-use history was not recorded in 22% of the charts. Alcohol abuse was recorded in 21% of them. A retrospective chart audit of patients previously discharged from the same wards revealed that psychiatric or other substance abuse consultation had been requested for only 21% of patients in whom a clear-cut alcohol abuse history had been obtained and recorded. These data suggest the need for more screening and consultation for alcohol abuse by primary care physicians and more involvement of consultation-liaison psychiatrists in the care of patients with alcohol abuse.

Teaching psychiatry to primary care internists

Many patients who seek the care of primary care physicians are suffering from a wide variety of psychiatric disorders. Primary care physicians should become skilled in interviewing techniques and basic psychiatric differential diagnosis, management, and treatment approaches for some types of psychiatric disorders and learn to regularly consult with and make referrals to psychiatrists when appropriate. Psychiatrists should play a very active role in the education of primary care specialists. This should include observation of the physician interviewing patients with different types of psychiatric disorders in addition to didactic teaching and supervision on topics such as psychopharmacology. With mutual collaboration between primary care interests and psychiatrists the patients of both groups of physicians should receive better care and continuing education of both may occur through an ongoing dialogue.

The effect of thioridazine on prolactinoma growth in a schizophrenic man: Case report

Thioridazine was found to increase the serum prolactin level as well as the tumor size of a prolactin--secreting pituitary chromophobe adenoma in a schizophrenic man. He was then successfully treated with clonidine, an antinoradrenergic compound without antidopaminergic properties, which had no effect on serum prolactin or tumor growth. This case report highlights the importance of careful neuroleptic usage in patients in whom elevated prolactin levels are of concern and discusses alternative methods of treating psychosis when antidopaminergic medications are contraindicated.

Psychiatric Aspects of Asthma in Adults

Asthma is a complex and multifactorial illness. Early theories focused on the psychosomatic aspects of this disease and more work has been done through the years to explore these theories and to further elucidate the variety of psychiatric conflicts, personality traits, and stressors, and the role they play in asthma. More recently, mechanisms have been postulated whereby these conflicts can influence the pathologic process in the lungs causing symptoms of asthma. These seem to act at the level of the limbic system and hypothalamus, the autonomic nervous system, and the immunologic system. Many psychiatric factors play a strong role in maintenance of the asthma. Family interactions, anxiety, depression, panic-fear, and many others can facilitate or impede compliance with an appropriate medical regimen. Although all these variables have yet to be sorted out definitively, asthma is certainly an area where psychiatrists can have a major therapeutic impact.

Some methodological issues in consultation-liaison psychiatry research

This is a research methodologic design model that may be useful to consultation-liaison psychiatrists. It is intended to facilitate such researchers in setting up and executing carefully controlled studies of the effectiveness (in psychiatric, medical, surgical, functional, cost, or other areas) of consultation-liaison interventions. The specific variables discussed are areas of particular interest to the authors, but many other variables may be readily substituted into this basic model. The design may be expanded or contracted relatively easily as would be appropriate for particular projects. The overall purpose of this paper is, hopefully, to serve as a catalyst for consultation-liaison psychiatrists to consider such research in their academic settings and to foster increased discussion and critical thinking regarding such research. The authors consider such research efforts important for the future regarding the scientific basis, proven effectiveness, and funding of consultation-liaison and general hospital psychiatry.

Family Physicians' Perceptions of Psychosocial Disorders: Survey Report and Educational Implications

One-hundred seventy-seven family physicians were surveyed regarding their perceptions of the types of psychosocial problems encountered in their practices, the amount of time they felt they devoted to each problem, and their interests regarding continuing psychiatric education. Patients with “multiple somatic complaints” and “symptoms of emotional distress” were reported as being encountered most frequently. Marital and family problems, alcoholism and sexual dysfunction were also ranked highly. The physicians indicated the highest interest in managing these disorders in addition to treatment of the suicidal patient. The implications of these results for psychiatric educators and liaison psychiatrists are discussed. The authors recommend using DSM-III diagnostic criteria applicable to these syndromes in formulating educational programs for primary care physicians.

Challenges and Opportunities for Consultation-Liaison Psychiatry in the Managed Care Environment

While the evolving managed care revolution is dramatically changing the clinical, educational, and economic systems in which consultation-liaison (C-L) psychiatrists must operate, this revolution also present several important opportunities for those in C-L psychiatry. The authors, who are academic department chairs and formerly directed C-L divisions, discuss C-L psychiatrys potential involvement and suggest approaches to effectively address key aspects of these changes.