Medical Specialties Commons^™

Functional, Cognitive And Psychological Outcomes, And Recurrent Vascular Events In Pakistani Stroke Survivors: A Cross Sectional Study., Maria Khan, Bilal Ahmed, Maryam Ahmed, Myda Najeeb, Emmon Raza, Farid Khan, Anoosh Moin, Dania Shujaat, Ahmed Arshad, Ayeesha Kamran Kamal

Department of Medicine

Background: There is little direct data describing the outcomes and recurrent vascular morbidity and mortality of stroke survivors from low and middle income countries like Pakistan. This study describes functional, cognitive and vascular morbidity and mortality of Pakistani stroke survivors discharged from a dedicated stroke center within a nonprofit tertiary care hospital based in a multiethnic city with a population of more than 20 million.

Methods: Patients with stroke, aged > 18 years, discharged alive from a tertiary care centre were contacted via telephone and a cross sectional study was conducted. All the discharges were contacted. Patients or their legal surrogate …

My Patient Has An Elevated Hs-Crp. What Does This Mean? What Should I Do Now?, Maria Khan, Emmon Raza, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

The Efficacy And Toxicity Of Bupropion In The Elderly, William T. Howard M.D., M.S., Julia K. Warnock M.D., Ph.D.

Jefferson Journal of Psychiatry

Bupropion is an antidepressant with excellent tolerability and few side effects or drug interactions. These characteristics suite it well for use both in the elderly and in the medically ill. However, early reports of seizures with bupropion therapy in patients with bulimia limited its use. The pharmacology, efficacy, toxicity, and side effect profile of both the immediate release (IR) and the recently available sustained release (SR) formulations of bupropion are reviewed. Bupropion SR is associated with a reduced seizure incidence (0.1%) compared to that found with the IR formulation (0.4%). Recent reports, however, demonstrate that the half-life of bupropion is …

The Malingering Of Psychotic Disorders, Michael R. Harris M.D.

Jefferson Journal of Psychiatry

The phenomenon of malingered psychosis is examined through a review of the available literature. Possible motivations for malingering are discussed, and clinical indicators of feigned psychotic symptoms are reviewed. The methods discussed focus on the inpatient evaluation of suspected malingerers and include discussions of interview techniques and psychometric testing to supplement clinical impressions. A differential diagnosis is presented, and techniques for confronting a malingering patient are reviewed.

Thoratec Heartmate Ii(®) Left Ventricular Assist Device Implantation In Patient With Patent Ventriculoperitoneal Shunt., Kentaro Yamane, Linda J Bogar, Shigeki Tabata, Hitoshi Hirose

Department of Surgery Faculty Papers

We report a case of HeartMate II® left ventricular assist device (LVAD) implantation as a destination therapy in a patient with a patent ventriculoperitoneal (VP) shunt after being suffered from subarachnoid hemorrhage. Because the patient's VP shunt was running through her right anterior chest and abdominal wall, a driveline exit site was selected in her left upper quadrant to avoid unnecessary perioperative complication in relation to the patent VP shunt tube. Tailored driveline placement was a key element of this LVAD implantation in this already sick patient with multiple comorbidities.

Lilliputian Hallucinations And Marijuana Dependence In A Bipolar Patient, Matthew L. Bush M.S. Iv, Saurabh Gupta M.D.

Jefferson Journal of Psychiatry

Lilluputian hallucinations are rarely seen in manic patients. Here we present a case of isolated lilluputian hallucinations against a backdrop of psychosis and marijuana use. The phenomenon is interesting and worth following up with. The patient recovered and a brief literature search is included.

A New Onset Paranoid Psychosis Associated With Fluoxetine And Bupropion: A Case Report, Vassili V. Arkadiev M.D., Stephen L. Ruedrich M.D.

Jefferson Journal of Psychiatry

No abstract provided.

Current Methodological Issues In Candidate Gene Association Studies In Psychiatric Disorders, Leo Sher M.D.

Jefferson Journal of Psychiatry

One of the most rapidly emerging areas of neuroscience research is the study of genetic approaches to complex psychiatric disorders. The author discusses potential benefits and pitfalls of candidate gene association studies. Association studies search for correlations in the population between a DNA marker and a disorder. The so-called candidate gene approach is frequently used in association studies. Candidate gene studies are usually based on hypotheses about relationships between specific known loci and particular phenotypes. The aim of molecular genetic studies of behavioral disorders includes the development of predictive and diagnostic testing for psychiatric disorders that can help to establish …

Addiction Professionals' Attitudes Regarding Treatment Of Nicotine Dependence, Baljit S. Gill M.D., Dwayne L. Bennett M.D., Mohammad Abu-Salha M.D., Lisa Fore-Arcand Ed.D.

Jefferson Journal of Psychiatry

The objectives of this study were: to establish the extent to which addiction professionals are willing to treat nicotine addiction concurrently with other addictions, and to evaluate what factors affect their attitudes.

A 21-item questionnaire was developed and distributed to therapists, physicians and other mental health workers in different treatment settings in Southeastern Virginia.

CD staffers own smoking histories were significantly related to: their perceptions of the impact of nicotine use, and how likely they were to intervene in patients' nicotine use. Intervention in CD staffers own smoking behavior may increase the treatment of nicotine dependence in their patients.

Psychosis In Azheimer's Disease, George M. Strickland M.D., Thomas F. Ditzler Ph.D.

Jefferson Journal of Psychiatry

Much of the basic science literature on Alzheimer's Disease (AD) reflects ongoing research into pathophysiology and neuropathology. Yet, despite reports of the association between psychotic symptoms and Alzheimer's disease, relatively little is known about why such symptoms develop in certain patients and not in others. Neuroimaging and genetic studies may provide greater understanding of this association and allow clinicians and researchers to prevent, predict and treat the onset of psychotic symptoms in the future. This paper will review the current literature on the topic of psychosis in Alzheimer's disease and focus on current recommendations for interventions by clinicians and caregivers.

Neuroleptic Malignant Syndrome: Review, Diagnostic Critique, Khurram K. Durrani M.D.

Jefferson Journal of Psychiatry

Neuroleptic malignant syndrome (NMS) can be defined as an idiosyncratic and potentially fatal reaction to neuroleptic agents that consists of fever, mental status changes, muscle rigidity, autonomic dysfunction, respiratory distress and rhabdomyolysis. The pathogenesis of NMS is still not fully understood. The diagnosis presents a challenge and the diagnostic criteria need further refinement. The presentation and course of NMS are quite variable and can range from a progressive, fulminating, downhill course to a relatively benign and self-limiting course. Despite great improvements in the management of the syndrome, prevention and early diagnosis are the most important aspects of treatment.

Treatment Response Of Opium Smoking Hmong Refugees To Methadone Maintenance, Muhammad Waqar Azeem M.D., Gregory A. Carlson B.A., Chomehanh Soudaly Lpn

Jefferson Journal of Psychiatry

Objective: To examine the outcome of methadone maintenance in opium dependent Hmong refugees.

Methods: Medical records were searched for Hmong patients in methadone treatment between 01/1995 and 09/1997. Patient's progress was assessed over nine months.

Results: 44 Hmong patients were found. Data was available on 40 patients, mean age of 47.7 years, 33 males/7 females. At admission 100% met the DSM-IV criteria for Opium Dependence, 75% Major Depressive Disorder and 68% PTSD. Patients showed marked improvement by having mostly negative urine drug screens, improvement on Addiction Severity Index and 70% being highly successful on outcome criteria modified by Drug Abuse …

Editor's Note, Manoj Mohata M.D.

Jefferson Journal of Psychiatry

No abstract provided.

Direct Evidence For Inhibition Of Mitochondrial Permeability Transition Pore Opening By Sevoflurane Preconditioning In Cardiomyocytes: Comparison With Cyclosporine A., Anna Onishi, Masami Miyamae, Kazuhiro Kaneda, Junichiro Kotani, Vincent M. Figueredo

Division of Cardiology Faculty Papers

To assess whether sevoflurane preconditioning is associated with inhibition of mitochondrial permeability transition pore (MPTP), the effects of sevoflurane were compared with those of cyclosporine A, a known inhibitor of MPTP opening. Isolated perfused guinea pig hearts underwent 30 min global ischemia and 120 min reperfusion (control). Sevoflurane preconditioning was elicited by administration of 2% sevoflurane for 10 min with 10 min washout before ischemia (sevoflurane). A preconditioning-like cardioprotection was also induced by administering cyclosporine A (0.2 μM) for 15 min, starting 5 min before ischemia and for 10 min after the onset of reperfusion (cyclosporine A). Left ventricular developed …

Longitudinal Impact Of The Project Paths On Adolescent Risk Behavior: What Happened After Five Years?, Daniel T. L. Shek, Lu Yu

Pediatrics Faculty Publications

The present study investigated the longitudinal impact of the Project PATHS, a large-scale curriculum-based positive youth development program in Hong Kong, on the development of adolescents' risk behavior over a period of five years. Using a longitudinal randomized controlled design, eight waves of data were collected from 19 experimental schools in which students participated in the Project PATHS (N = 2,850 at Wave 8) and 24 control schools without joining the Project PATHS (N = 3,640 at Wave 8). At each wave, students responded to measures assessing their current risk behaviors, including delinquency, use of different types of drug, and …

Mechanisms Of Fetal Programming In Hypertension., John E. Jones, Julie A. Jurgens, Sarah A. Evans, Riley C. Ennis, Van Anthony Villar, Pedro A. Jose

Pediatrics Faculty Publications

Events that occur in the early fetal environment have been linked to long-term health and lifespan consequences in the adult. Intrauterine growth restriction (IUGR), which may occur as a result of nutrient insufficiency, exposure to hormones, or disruptions in placental structure or function, may induce the fetus to alter its developmental program in order to adapt to the new conditions. IUGR may result in a decrease in the expression of genes that are responsible for nephrogenesis as nutrients are rerouted to the development of more essential organs. Fetal survival under these conditions often results in low birth weight and a …

Psychiatric Training: The Culture And Its Contradictions By T.M. Luhrmann, Carolyn Myers M.D.

Jefferson Journal of Psychiatry

No abstract provided.

Glenohumeral Tuberculous Arthritis Complicated With Beta Haemolytic Streptococcus: An Extraordinary Rare Association: A Case Report, Rizwan Haroon Rashid, Muhammad Usman Sarwar, Jaweed Akhter, Shahryar Noordin

Section of Orthopaedic Surgery

Introduction: Septic arthritis of the glenohumeral joint is a rare entity and its diagnosis is difficult with a superadded infection in the presence of underlying tuberculosis. We report the first case of group B beta haemolytic streptococcal glenohumeral arthritis with underlying tuberculosis.
Case Presentation: A 40 year old lady previously diagnosed to have poliomyelitis, rheumatoid arthritis, hepatitis C, and diabetes mellitus for the last 10 years, presented to the emergency room with diabetic ketoacidosis. Two weeks prior to presentation she developed fever along with pain and swelling in left shoulder with uncontrolled blood sugars. Local examination of the shoulder revealed …

Understanding Unintentional Childhood Home Injuries: Pilot Surveillance Data From Karachi, Pakistan., Nukhba Zia, Uzma R. Khan, J. Razzak, Prasanthi Puvanachandra, Adnan A. Hyder

Department of Emergency Medicine

Background: Childhood injuries, an important public health issue, globally affects more than 95% of children living in low-and middle-income countries. The objective of this study is to describe the epidemiology of childhood unintentional injuries in Karachi, Pakistan with a specific focus on those occurring within the home environment.
Methods:This was a secondary analysis of a childhood unintentional injury surveillance database setup in the emergency department of the Aga Khan Hospital, Karachi, Pakistan for 3 months. The data was collected by interviewing caretakers of children under 12 years of age presenting with an unintentional injury to the emergency departments of …

Primary Care Providers’ Perspectives On Online Weight-Loss Programs: A Big Wish List, Kevin O Hwang, Heather L Stuckey, Monica C Chen, Jennifer L Kraschnewski, Samuel N Forjuoh, Jennifer M Poger, Kathleen M Mctigue, Christopher N Sciamanna

Faculty, Staff and Student Publications

BACKGROUND: Integrating online weight-loss programs into the primary care setting could yield substantial public health benefit. Little is known about primary care providers' perspectives on online weight-loss programs.

OBJECTIVE: To assess primary care providers' perspectives on online weight-loss programs.

METHODS: We conducted focus group discussions with providers in family medicine, internal medicine, and combined internal medicine/pediatrics in Texas and Pennsylvania, USA. Open-ended questions addressed their experience with and attitudes toward online weight-loss programs; useful characteristics of existing online weight-loss programs; barriers to referring patients to online weight-loss programs; and preferred characteristics of an ideal online weight-loss program. Transcripts were analyzed …

Methylphenidate, Bupropion, And Ssri Triple Therapy, William Bobo M.D.

Jefferson Journal of Psychiatry

Methylphenidate and bupropion have been demonstrated as being effective adjuncts to serotonin reuptake inhibitors in the treatment of depression (1,2). The use of these medications in case of a depressed patient whose condition was resistant to several forms of monotherapy, monotherapy with "standard" augmentation and ECT. After only a partial response to fluoxetine and methylphenidate, bupropion was added, resulting in full, sustained remission.

Severe Generalized Edema Associated With Phenelzine, William Bobo M.D., Cheryl A. Hemme M.D.

Jefferson Journal of Psychiatry

Rabkin, et al. describes a 4% incidence of phenelzine-induced edema, which appears to be due to increased capillary permeability (1,2). This adverse effect is not further characterized in the literature and is not readily mentioned as one of the many drug effects that could result in severe physical morbidity. We present the case of a depressed patient who developed a generalized edema severe enough to deserve an extensive medical workup. Once the drug was tapered, the edema and its associated symptoms rapidly resolved.

Personality Traits In Juvenile Delinquents: Associations With Peer And Family Relations, Jeffrey J. Wilson M.D., Sharon E. Willams Ph.D., Evan Garner M.D., Elaine Duxbury B.A., Hans Steiner Dr. Med. Univ.

Jefferson Journal of Psychiatry

Objective: To establish family and peer correlates of personality traits shown to be predictive of future criminal recidivism.

Method: 137 incarcerated boys aged 13-18 (x = 16 ± 1.2), 35% black, 21% Hispanic, 43% white, and 1% other completed the Weinberger Adjustment Inventory (WAI) and a psychosocial history obtained by a social worker. Records were summarized using two raters who assigned numerical ratings to dimensions of family and peer relations.

Results: As expected, observer ratings of family and peer relationships were correlated with the personality characteristics of distress, denial and restraint as measured by the WAI.

Conclusion: Family and peer …

What's New In Adult Reconstructive Knee Surgery., Carl A Deirmengian, Jess H Lonner

Rothman Institute Papers

The purpose of this review is to summarize studies on various topics in adult knee reconstruction that were published during the year 2010. The keywords “knee” and “arthroplasty” and “prospective” and “randomized” were used to perform a search of the National Library of Medicine's PubMed database; the search was limited to studies that were published in The Journal of Bone and Joint Surgery (American Volume) or The Journal of Arthroplasty in 2010. The resulting seventeen studies are included in this review of adult reconstruction of the knee and are included in the complete bibliography at the end of the manuscript. …

Folie A Famille Associated With Amphetamine Use, Kevin P. Hill B.A., Ashwin A. Patkar M.D., Stephen P. Weinstein Ph.D.

Jefferson Journal of Psychiatry

Shared Psychotic Disorder involving an entire family (folie a famille) is extremely rare. Only two cases of Shared Psychotic Disorder linked to stimulant abuse have been documented in the literature. We report a case of folie a famille that involved 5 members of a family, and was associated with amphetamine use in the primary individual. Our case shares many clinical and etilogical factors with previously reported cases of shared psychotic disorders. A wide variety of psychotic manifestations are associated with amphetamine use and clinicians should be aware of this uncommon syndrome among stimulant-using population, particularly due to the recent increase …

Countertransference In Two Settings: A Case Report, Randi L. Plotkin M.D.

Jefferson Journal of Psychiatry

No abstract provided.

Conversion Disorder In A Depressed Patient: The Analysis Of Paralysis, Michael A. Chen Ph.D., David S. Im M.D.

Jefferson Journal of Psychiatry

Patients presenting with neurologic and pseudoneurologic symptoms present both a diagnostic and treatment challenge. This case report describes the ER course of a man who presented with aphonia and paralysis, his medical clearance, transfer to the psychiatric ER and subsequent recovery. The history of conversion disorder and its characteristics are briefly reviewed, and the etiology of this patient's symptoms and a discussion of effective treatment plans are discussed.

Patient Violence In Psychiatric Residency: A Nationwide Survey, Tricia L. Park Ph.D., Thomas L. Schwartz M.D.

Jefferson Journal of Psychiatry

Twenty percent of current psychiatric residents (N = 517) responded to a nationwide survey about patient violence. Thirty six percent of responders reported 630 assaults, with 74% of residents receiving 1,853 threats. While age and training level were correlated to each other (r = .35, p < .001), no correlations were found between gender, age, height, weight number of hours of violence management training and the occurrence of assault and threat. A smaller proportion of first year residents reported assaults and threats, and more males (79%) had been threatened (females = 69%). Sources of study bias are identified and future research directions are outlined.

Editor's Column, Scot R. Maclean M.D.

Jefferson Journal of Psychiatry

No abstract provided.

About The Authors

Jefferson Journal of Psychiatry

No abstract provided.