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1.
Aging Ment Health ; 9(2): 172-6, 2005 Mar.
Article in English | MEDLINE | ID: mdl-15804636

ABSTRACT

Information regarding older adult emergency center (EC) patient characteristics remains limited, despite its increasing importance in health care delivery systems. This retrospective study encompasses all EC visits over an eight-year period (n = 825,682) to a large urban county hospital. Only participants with a primary psychiatric diagnosis were examined, and included a total of 53,894 adults, 18-64 years old and 1,478 adults, > or =65 years old. Despite an increasing aging population, EC visits for older adults with psychiatric disorders did not increase over time. Within the older adult sample, cognitive, psychotic, and bipolar disorders were associated with higher rates of admission to the hospital, while substance use, depressive, and anxiety disorders were associated with lower numbers of inpatient admissions. African-Americans were over-represented in the EC and admitted to the hospital at higher rates, compared to other ethnic groups. Caucasian patients were the group most frequently diagnosed with a substance use disorder. In conclusion, differences in race, and diagnosis support the idea that such variables directly relate to utilization rates, presentation, and disposition within the EC.


Subject(s)
Emergency Services, Psychiatric/statistics & numerical data , Mental Disorders/rehabilitation , Adolescent , Adult , Aged , Anxiety Disorders/epidemiology , Anxiety Disorders/rehabilitation , Bipolar Disorder/epidemiology , Bipolar Disorder/rehabilitation , Cognition Disorders/epidemiology , Cognition Disorders/rehabilitation , Depressive Disorder/epidemiology , Depressive Disorder/rehabilitation , Female , Hospitalization , Humans , Incidence , Male , Mental Disorders/epidemiology , Middle Aged , Psychotic Disorders/epidemiology , Psychotic Disorders/rehabilitation , Substance-Related Disorders/epidemiology , Substance-Related Disorders/rehabilitation
2.
J Am Acad Dermatol ; 45(4): 596-600, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11568753

ABSTRACT

Rheumatoid neutrophilic dermatitis (RND) is an unusual cutaneous reaction in patients with rheumatoid arthritis (RA). RND is characterized by symmetric, erythematous papules, plaques, nodules, and urticarial lesions often located over the joints, extensor surfaces of the extremities, or the trunk. This entity demonstrates an intense neutrophilic dermal infiltrate without vasculitis. All patients previously reported with RND had severe RA with relatively high titers of rheumatoid factor when tested. A 67-year-old woman had a 2-month history of multiple, tender, 4 to 8 mm erythematous, crusted papules and nodules that occurred in clusters on her anterior thighs, knees, and legs. She suffered from severe disabling seronegative RA. RND may complicate seronegative RA.


Subject(s)
Arthritis, Rheumatoid/complications , Dermatitis/immunology , Aged , Arthritis, Rheumatoid/immunology , False Negative Reactions , Female , Humans , Neutrophils/immunology , Serologic Tests
3.
Psychiatr Serv ; 51(4): 522-4, 2000 Apr.
Article in English | MEDLINE | ID: mdl-10737830

ABSTRACT

Variables associated with successful completion of guardianship applications for elderly patients were identified. Thirteen patients for whom applications were approved were compared with 26 whose applications did not reach the court. Patients for whom the process was successful scored significantly higher on the anergia-depression subscale of the Brief Psychiatric Rating Scale and had significantly more medical conditions in the past year. A survey of next of kin revealed that the process had a much better chance of success when the unit social worker made the guardianship recommendation and when family members were given more information about the taxing and time-consuming process of obtaining guardianship.


Subject(s)
Frail Elderly/psychology , Legal Guardians , Mental Competency/legislation & jurisprudence , Aged , Aged, 80 and over , Dementia/diagnosis , Dementia/psychology , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Female , Humans , Male , Middle Aged , Motivation , Texas
4.
Radiology ; 214(1): 227-30, 2000 Jan.
Article in English | MEDLINE | ID: mdl-10644129

ABSTRACT

This article summarizes the current theories regarding the locations and functions of the three primary frontal lobe circuits. It forms the framework for structuring functional magnetic resonance imaging investigations. It can be used to assist in (a) detecting subtle lesions of the frontal circuits and (b) applying the current theories of neuropsychiatry to assess prognosis and to plan rehabilitation.


Subject(s)
Brain Mapping , Frontal Lobe/physiology , Magnetic Resonance Imaging , Nerve Net/physiology , Brain Diseases/pathology , Brain Diseases/physiopathology , Frontal Lobe/pathology , Humans , Nerve Net/pathology , Neurocognitive Disorders/pathology , Neurocognitive Disorders/physiopathology , Prognosis
5.
J Neuropsychiatry Clin Neurosci ; 11(1): 100-2, 1999.
Article in English | MEDLINE | ID: mdl-9990564

ABSTRACT

Akinetic mutism is characterized by alertness with near complete absence of volitional activity. The authors report a case of episodically remitting akinetic mutism following subarachnoid hemorrhage.


Subject(s)
Catatonia/etiology , Hypokinesia/etiology , Mutism/etiology , Subarachnoid Hemorrhage/complications , Catatonia/diagnosis , Catatonia/physiopathology , Chronic Disease , Diagnosis, Differential , Disease Progression , Humans , Hypokinesia/diagnosis , Hypokinesia/physiopathology , Male , Middle Aged , Mutism/diagnosis , Mutism/physiopathology , Seizures , Sleep Stages , Subarachnoid Hemorrhage/surgery
7.
J Am Acad Dermatol ; 35(5 Pt 1): 720-4, 1996 Nov.
Article in English | MEDLINE | ID: mdl-8912567

ABSTRACT

BACKGROUND: Pyoderma gangrenosum (PG) may fail to respond to corticosteroids. Immunosuppressive and cytotoxic agents are useful in patients with recalcitrant disease. We describe our experiences with chlorambucil for PG. OBJECTIVE: Our purpose was to evaluate the effectiveness of oral chlorambucil in patients with PG recalcitrant to treatment with prednisone, immunosuppressive therapy, or both. METHODS: Six patients with recalcitrant PG were given oral chlorambucil 2 to 4 mg/day. Four patients were treated with a combination of prednisone and chlorambucil, and two received chlorambucil alone. Response was based on (1) a diminution in the size of the ulcers, or their complete healing, or (2) a decrease in the dose of corticosteroid therapy. RESULTS: Beneficial effects were noted within 6 to 8 weeks in all six patients, and corticosteroids were eventually discontinued in all patients. Currently only two patients are still receiving chlorambucil; the other four stopped chlorambucil after 6 to 24 months of treatment. Their disease has remained in remission for 4 to 9 years. Relapse of disease occurred within 1 to 4 months after stopping therapy in one of the two remaining patients or reducing the dose in the other. In both patients, the disease is again responding to treatment. Minimal chlorambucil toxicity has been noted, consisting of leukopenia in one patient. CONCLUSION: Our findings suggest that chlorambucil is an effective corticosteroid-sparing agent for the control of PG.


Subject(s)
Antineoplastic Agents, Alkylating/therapeutic use , Chlorambucil/therapeutic use , Pyoderma Gangrenosum/drug therapy , Adult , Female , Humans , Male , Middle Aged , Pyoderma Gangrenosum/pathology
9.
J Am Acad Dermatol ; 29(5 Pt 2): 838-40, 1993 Nov.
Article in English | MEDLINE | ID: mdl-8408822

ABSTRACT

Thrombotic thrombocytopenic purpura is a rare disease most commonly associated with microangiopathic hemolytic anemia, thrombocytopenia, fever, neurologic disorders, and renal dysfunction. We describe a patient with a history of thrombotic thrombocytopenic purpura that had been quiescent for 4 months; he had a 3-week history of painful purpuric lesions on the left hand only. He also had mottling and a livedoid purpura of the distal fingertips, splinter hemorrhages of the left fingernails, and a decreased radial pulse. Findings of a biopsy specimen revealed multiple capillary and small vessel thromboses. Contrast aortography demonstrated a pseudoaneurysm of the proximal descending thoracic aorta with stenosis of the left subclavian artery at its origin and an associated thrombus.


Subject(s)
Aortic Aneurysm, Thoracic/complications , Embolism/etiology , Purpura, Thrombotic Thrombocytopenic/complications , Adult , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortography , Biopsy , Embolism/pathology , Humans , Male
10.
Arch Dermatol ; 127(4): 515-22, 1991 Apr.
Article in English | MEDLINE | ID: mdl-2006876

ABSTRACT

Azathioprine sodium has been reported to be effective therapy for chronic cutaneous lupus erythematosus (LE) but rarely for chronic cutaneous leukocytoclastic vasculitis (LV). We used azathioprine in the treatment of six patients with cutaneous LE, four of whom had subacute cutaneous (nonscarring) LE and two of whom had chronic cutaneous (scarring, discoid) LE, and six patients with chronic cutaneous LV. The conditions of all patients had been resistant to conventional therapy, and they required long-term oral corticosteroid therapy for control of their disease. Two of the patients with LE had prominent palmar and/or plantar involvement. Three patients with LE had an excellent response to azathioprine, with near complete clearing of the skin lesions, allowing a decrease in prednisone dosage. One patient with LE initially demonstrated significant improvement, but azathioprine therapy had to be discontinued because of pancreatitis. The treatment failed in two patients with LE; one had nausea and the other repeatedly developed a drug-induced fever. Five of the six patients with LV had improved conditions, with complete control of the disease occurring in two patients and partial control in three patients. Azathioprine is effective for some patients with cutaneous LE and chronic cutaneous LV, but it should be reserved for patients with severe disease in whom more conventional treatment fails.


Subject(s)
Azathioprine/therapeutic use , Lupus Erythematosus, Cutaneous/drug therapy , Vasculitis, Leukocytoclastic, Cutaneous/drug therapy , Adult , Female , Humans , Lupus Erythematosus, Cutaneous/blood , Male , Middle Aged , Vasculitis, Leukocytoclastic, Cutaneous/blood
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