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1.
J Neurol Neurosurg Psychiatry ; 72(3): 403-5, 2002 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11861708

RESUMO

BACKGROUND: It remains unclear from lesion studies whether the four signs of the Gerstmann syndrome (finger agnosia, acalculia, agraphia, and right-left confusion) cluster because the neuronal nets that mediate these activities have anatomical proximity, or because these four functions share a common network. If there is a common network, with degeneration, as may occur in Alzheimer's disease, each of the signs associated with Gerstmann's syndrome should correlate with the other three signs more closely than they correlate with other cognitive deficits. METHODS: Thirty eight patients with probable Alzheimer's disease were included in a retrospective analysis of neuropsychological functions. RESULTS: The four Gerstmann's syndrome signs did not cluster together. Finger naming and calculations were not significantly correlated. Right-left knowledge and calculations also did not correlate. CONCLUSIONS: The four cognitive functions impaired in Gerstmann's syndrome do not share a common neuronal network, and their co-occurrence with dominant parietal lobe injuries may be related to the anatomical proximity of the different networks mediating these functions.


Assuntos
Doença de Alzheimer/diagnóstico , Síndrome de Gerstmann/diagnóstico , Testes Neuropsicológicos , Adulto , Idoso , Doença de Alzheimer/fisiopatologia , Anomia/diagnóstico , Anomia/fisiopatologia , Diagnóstico Diferencial , Dominância Cerebral/fisiologia , Feminino , Síndrome de Gerstmann/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Rede Nervosa/fisiopatologia , Lobo Parietal/fisiopatologia , Resolução de Problemas
2.
Biol Psychiatry ; 47(9): 804-12, 2000 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-10812039

RESUMO

BACKGROUND: Perpetrators of domestic violence frequently report symptoms of autonomic arousal and a sense of fear and/or loss of control at the time of the violence. Since many of these symptoms are also associated with panic attacks, we hypothesized that perpetrators of domestic violence and patients with panic attacks may share similar exaggerated fear-related behaviors. To test this hypothesis, we employed the panicogenic agent sodium lactate to examine the response of perpetrators to anxiety fear induced by a chemical agent. METHODS: Using a double-blind, placebo-controlled design, we infused 0.5 mol/L sodium lactate or placebo over 20 min on separate days to a select group of subjects who perpetrate acts of domestic violence and two nonviolent comparison groups. We compared their behavioral, neuroendocrine, and physiologic responses. RESULTS: Lactate administration elicited intense emotional responses in the perpetrators of domestic violence. Perpetrators evidenced more lactate-induced rage and panic and showed greater changes in speech, breathing, and motor activity than did nonviolent control subjects. There were no significant differences between the groups for any neuroendocrine or physiologic measure. CONCLUSIONS: These results are consistent with our hypothesis that some perpetrators of domestic violence have exaggerated fear-related behavioral responses.


Assuntos
Violência Doméstica/psicologia , Ácido Láctico/farmacologia , Pânico/efeitos dos fármacos , Fúria/efeitos dos fármacos , Adulto , Alcoolismo/psicologia , Pressão Sanguínea/efeitos dos fármacos , Método Duplo-Cego , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Infusões Intravenosas , Masculino , Escalas de Graduação Psiquiátrica , Fatores Socioeconômicos , Gravação de Videoteipe
3.
Healthc Financ Manage ; 54(10): 56-8, 2000 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11183545

RESUMO

Conducting a thorough due diligence is essential for any buyer that plans to acquire a healthcare entity, including a hospital or a group practice, because it provides an opportunity for the buyer to uncover billing or other fraud-and-abuse problems within the selling organization. These problems can be significant, because the buyer can be held liable for undiscovered billing problems that result in investigation, prosecution, and penalties. It is important for the buyer to ascertain who bears the liability of fraud-and-abuse violations and attempt to protect itself from assuming such liability.


Assuntos
Auditoria Financeira , Fraude/prevenção & controle , Instituições Associadas de Saúde/legislação & jurisprudência , Responsabilidade Legal , Determinação do Valor Econômico de Organizações de Saúde/legislação & jurisprudência , Fraude/legislação & jurisprudência , Fidelidade a Diretrizes , Instituições Associadas de Saúde/economia , Departamentos Hospitalares/economia , Responsabilidade Legal/economia , Determinação do Valor Econômico de Organizações de Saúde/economia , Gestão de Riscos , Estados Unidos
4.
Am J Psychiatry ; 155(11): 1544-9, 1998 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-9812115

RESUMO

OBJECTIVE: Dysfunction of monoamine uptake mechanisms has been implicated in the pathogenesis of alcohol dependence. The authors explored whether serotonergic dysfunction is associated with anxiety and depression, which increase the risk of relapse in alcoholics. METHOD: The availability of serotonin and dopamine transporters in 22 male alcoholics and 13 healthy male volunteers was measured with the use of [123I] beta-CIT and single photon emission computed tomography, and psychopathological correlates were assessed. RESULTS: A significant reduction (a mean of about 30%) in the availability of brainstem serotonin transporters was found in the alcoholics, which was significantly correlated with lifetime alcohol consumption and with ratings of depression and anxiety during withdrawal. CONCLUSIONS: The findings support the hypothesis of serotonergic dysfunction in alcoholism and in withdrawal-emergent depressive symptoms.


Assuntos
Alcoolismo/fisiopatologia , Proteínas de Transporte/fisiologia , Glicoproteínas de Membrana/fisiologia , Proteínas de Membrana Transportadoras , Proteínas do Tecido Nervoso , Serotonina/fisiologia , Adulto , Consumo de Bebidas Alcoólicas/metabolismo , Consumo de Bebidas Alcoólicas/fisiopatologia , Alcoolismo/metabolismo , Transtornos de Ansiedade/induzido quimicamente , Transtornos de Ansiedade/fisiopatologia , Tronco Encefálico/química , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/metabolismo , Proteínas de Transporte/análise , Proteínas de Transporte/metabolismo , Cocaína/análogos & derivados , Transtorno Depressivo/induzido quimicamente , Transtorno Depressivo/fisiopatologia , Dopamina/metabolismo , Dopamina/fisiologia , Proteínas da Membrana Plasmática de Transporte de Dopamina , Etanol/efeitos adversos , Humanos , Radioisótopos do Iodo , Masculino , Glicoproteínas de Membrana/análise , Glicoproteínas de Membrana/metabolismo , Pessoa de Meia-Idade , Recidiva , Fatores de Risco , Serotonina/análise , Serotonina/metabolismo , Proteínas da Membrana Plasmática de Transporte de Serotonina , Síndrome de Abstinência a Substâncias/etiologia , Síndrome de Abstinência a Substâncias/fisiopatologia , Tomografia Computadorizada de Emissão de Fóton Único
5.
J Fla Med Assoc ; 84(6): 391-6, 1997.
Artigo em Inglês | MEDLINE | ID: mdl-9379165

RESUMO

Medical care is becoming more technically challenging and community-based. The majority of patients and family health gatekeepers (the family member who regulates health care services for the family unit) are female, while the majority of physicians are male. Therefore, differences in female versus male methods of decision making add to the difficulty in making health choices. The female patient and family health gatekeeper may need new knowledge, skills and time to help them deal with difficult medical choices. They may benefit from a multidisciplinary, unbiased group of experts in the form of a Community Healthcare Committee. Trained to be responsible for the general health of the community, the primary care practitioner is ideal to take a leadership role in developing such a committee. A Community Healthcare Committee that understands different methods of health decision making could serve as a resource by providing community health education and private case reviews intended to help individuals with health care decisions.


Assuntos
Tomada de Decisões , Serviços de Saúde , Comportamento de Escolha , Competência Clínica , Serviços de Saúde Comunitária , Redes Comunitárias , Saúde da Família , Medicina de Família e Comunidade , Feminino , Educação em Saúde , Recursos em Saúde , Humanos , Liderança , Masculino , Ciência de Laboratório Médico , Equipe de Assistência ao Paciente , Relações Médico-Paciente , Atenção Primária à Saúde , Encaminhamento e Consulta , Caracteres Sexuais , Responsabilidade Social
7.
JAMA ; 273(2): 113-4, 1995 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-7799486
9.
J Neurol Neurosurg Psychiatry ; 56(12): 1282-9, 1993 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-8270928

RESUMO

Cholinergic deficient states, such as in Alzheimer's disease, are associated with amnesia. Therapeutic trials with cholinergic augmentation in Alzheimer's disease have had only equivocal results, but mechanisms other than cholinergic deficiency may contribute to the memory deficit. Normally the diagonal band of Broca provides much of the hippocampal cholinergic input. To learn if amnesia secondary to cholinergic deficiency can be ameliorated by cholinergic augmentation, we treated an amnestic man who had a lesion located primarily in the right diagonal band of Broca with physostigmine and lecithin. During the initial best-dose-finding phase, he demonstrated an inverted U-shaped curve for immediate recall of word lists, with peak performances at 3.0 and 3.5 mg of physostigmine. Single photon emission tomography showed decreased blood flow in the medial temporal region ipsilateral to the lesion at baseline, with a reversal of the asymmetry on 3.5 mg of physostigmine. A follow-up double-blind, placebo-controlled study on 3.5 mg of physostigmine, however, failed to demonstrate that cholinergic treatment improved memory.


Assuntos
Amnésia/tratamento farmacológico , Lobo Frontal/efeitos dos fármacos , Fisostigmina/uso terapêutico , Amnésia/psicologia , Encefalopatias/tratamento farmacológico , Encefalopatias/psicologia , Método Duplo-Cego , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/patologia , Humanos , Masculino , Rememoração Mental/efeitos dos fármacos , Pessoa de Meia-Idade , Testes Neuropsicológicos , Tomografia Computadorizada de Emissão de Fóton Único
10.
J Case Manag ; 2(4): 130-6, 1993.
Artigo em Inglês | MEDLINE | ID: mdl-8142912

RESUMO

Patients with a diagnosis of Alzheimer's disease and their families need the assistance of a case manager to deal with the issues of long-term care. The case manager assists with education, planning, linking to formal and informal resources, and addressing emotional needs in the family unit. This article discusses specific suggestions to address problems in the three stages of Alzheimer's disease from the time of medical diagnosis to the end of life.


Assuntos
Doença de Alzheimer , Assistência de Longa Duração/organização & administração , Programas de Assistência Gerenciada/organização & administração , Planejamento de Assistência ao Paciente , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/fisiopatologia , Doença de Alzheimer/psicologia , Humanos , Educação de Pacientes como Assunto
12.
J Fla Med Assoc ; 76(2): 259-60, 1989 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-2926375

RESUMO

The expected increased incidence of Alzheimer's disease and related dementias in the next century will impact heavily on the care of physicians to involved families. Physicians alone cannot provide the assistance required by these families and need to access other health professionals and resources to assist these families. Responding to the desperate need for information by families concerned with Alzheimer's disease, physicians and other health professionals in North Central Florida networked to develop, implement, and evaluate a responsive strategy, a community forum on Alzheimer's disease and related dementias. The two-hour daytime program with small discussion groups and a panel of experts for a question-answer session was highly successful and replicated.


Assuntos
Doença de Alzheimer/terapia , Relações Interprofissionais , Equipe de Assistência ao Paciente , Idoso , Recursos em Saúde , Humanos
14.
Science ; 155(3769): 1579-80, 1967 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-6020488

RESUMO

The ability of mink, fer rets, skunks, and cats to learn to dis criminate between objects was com pared. Performance of mink and fer rets was similar to that reported for primates. This observation suggests that there is considerable overlap among mammals in ability to form learning sets.


Assuntos
Comportamento Animal , Carnívoros , Aprendizagem por Discriminação , Animais , Gatos , Psicologia Comparada
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