{"title":"Detection and Triage of Urinary Incontinence Problems in a Psychiatric Practice","authors":"Morton A Stenchever MD","doi":"10.1016/S1082-7579(98)00006-5","DOIUrl":"10.1016/S1082-7579(98)00006-5","url":null,"abstract":"<div><p><span>Urinary incontinence is a common complaint in women, and the incidence increases with age. Since </span>continence is the result of the interaction of several neurologic, anatomic, and physiologic factors, it may be affected by a number of pathological conditions, physical changes, or pharmacologic agents. Psychiatrists are often the only physicians caring for women in an ongoing fashion. But patients are often embarrassed to discuss incontinence unless directly questioned. Thus, it is reasonable for a psychiatrist to ask about this problem, take a history to help determine whether the patient will respond to simple therapy or whether she may require referral. This paper will define the types of incontinence and the etiologic factors that may be the cause and will offer suggestions as to how the psychiatrist can evaluate the patient initially and decide on appropriate disposition of the patient with this problem.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 3","pages":"Pages 86-88"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(98)00006-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74267119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Subarachnoid Hemorrhage: Clinical Presentation and Neuropsychological Outcome","authors":"Gary L Bernardini MD, PhD , Stephan A Mayer MD","doi":"10.1016/S1082-7579(98)00007-7","DOIUrl":"10.1016/S1082-7579(98)00007-7","url":null,"abstract":"<div><p>Subarachnoid hemorrhage (SAH) following ruptured intracranial aneurysm affects 28,000 people each year in the United States. Despite advances in surgical treatment and a significant reduction in mortality over the past two decades, SAH remains a devastating disease. Although most survivors are free of physical handicap, a large percentage suffer from significant long-term cognitive and emotional disturbances. These may include deficits in memory, executive function, attention and concentration, psychomotor speed, language, anxiety, and depression. The severity of these deficits is attested to by the fact that over 50% of patients employed full time before SAH do not return to the same level of work. This article presents a review of the clinical presentation of SAH and the significant areas of neurological and cognitive dysfunction that occur after the hemorrhage.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 3","pages":"Pages 71-76"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(98)00007-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79840951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"HIV Infection in Women","authors":"Patrick Duff MD","doi":"10.1016/S1082-7579(98)00004-1","DOIUrl":"https://doi.org/10.1016/S1082-7579(98)00004-1","url":null,"abstract":"<div><p><span>Human immunodeficiency virus (HIV) infection is caused by an RNA retrovirus that is trophic for CD</span><sub>4</sub><span><span><span> lymphocytes. By attacking and ultimately destroying these cells, the virus causes a severe deficiency in cell-mediated immunity, rendering the host susceptible to a myriad of opportunistic infections and malignancies. HIV infection occurs in a continuum, ranging from the initial, acute retroviral illness to </span>florid<span><span> acquired immunodeficiency syndrome (AIDS). At the present time, more than 500,000 Americans have been afflicted with AIDS. More than one million Americans are in pre-AIDS stages of their illness. In the United States, 15 to 20% of patients with HIV infection are women. Among women, the two most important risk factors for infection are IV drug use and heterosexual contact with a high-risk male. Factors that increase the risk of sexual transmission of HIV infection include multiple partners, receptive anal intercourse, concurrent use of IV drugs or crack cocaine, other STDs, intercourse during menses or in the presence of ulcerative genital lesions, and contact with an uncircumcised male. More than 90% of all cases of HIV infection in children result from direct perinatal transmission from an infected mother. Transplacental dissemination and </span>intrapartum transmission are the two most important mechanisms of </span></span>perinatal infection. HIV infection can also be transmitted by breastfeeding and by close personal contact following delivery. The risk of vertical transmission can be reduced significantly by treating HIV-infected patients and their neonates with antiviral chemotherapy. Because HIV infection is such a severe, and usually, fatal illness, great emphasis should be placed on preventive measures. Mental health professionals can play a pivotal role in the management of HIV-infected patients, particularly in helping them cope with the terminal stages of their illness.</span></p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 3","pages":"Pages 77-81"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(98)00004-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137224651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Steven C Stoner PharmD, BCPP , Patricia A Marken PharmD, BCPP , Roger W Sommi Jr., PharmD, BCPP
{"title":"Psychiatric Comorbidity and Medical Illness","authors":"Steven C Stoner PharmD, BCPP , Patricia A Marken PharmD, BCPP , Roger W Sommi Jr., PharmD, BCPP","doi":"10.1016/S1082-7579(98)00008-9","DOIUrl":"10.1016/S1082-7579(98)00008-9","url":null,"abstract":"<div><p>A substantial amount of evidence is available that indicates comorbid psychiatric disorders are frequently unrecognized and untreated in medical illness. Furthermore, often times medical illnesses are not examined as possible contributors to the psychiatric condition. Anxiety, depression, and psychosis are all common psychiatric manifestations witnessed as comorbid states in primary health care. It is vital to the overall outcome and well-being of patients that comorbid states be identified and treated to improve quality of life, increase rates of compliance, improve psychosocial functioning, and decrease the total costs of treating the disease state. The following article emphasizes the importance of recognizing psychiatric comorbidity with medical illness and how these comorbid states are often overlooked. A number of disease states are reviewed that have been studied and shown to have improved outcomes and decreased mortality rates when both the psychiatric conditions and medical illness are treated.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 3","pages":"Pages 64-70"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(98)00008-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74814759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Antiepileptic drug-induced bone disease","authors":"PharmD Heather J. Clark","doi":"10.1016/S1082-7579(97)00095-2","DOIUrl":"10.1016/S1082-7579(97)00095-2","url":null,"abstract":"<div><p>Antiepileptic drug-induced bone disease, such as osteomalacia and osteoporosis, can occur with chronic treatment with antiepileptic drugs (AEDs). Chronic therapy with AEDs can cause vitamin, mineral, and bone metabolism disorders causing defects that can lead to symptomatic bone disease. The mechanism of development of these bone disorders is AED inhibition of intestinal calcium absorption and acceleration of conversion of vitamin D to nonbiologically active more polar metabolites by induced hepatic enzymes. These effects lead to decreased serum calcium, decreased circulating and tissue active vitamin D metabolite levels, decreased serum phosphate, increased PTH, and alterations in bone remodeling. Because patients are frequently treated for many years with AEDs, the risk for bone complications is often enhanced. AEDs that induce hepatic microsomal cytochrome P450 enzymes, such as phenytoin, phenobarbital, and carbamazepine, lower serum calcium, vitamin D, and 25-OHD levels in the body, which can lead to AED-induced bone disease. Other AEDs that do not induce hepatic microsomal cytochrome P450 enzymes, such as valproate and its derivatives, ethosuxamide, gabapentin, vigabatrin, and lamotrigine, do not affect serum calcium, vitamin D, and 25-OHD levels in the body, and do not cause AED-induced bone disease.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 2","pages":"Pages 58-61"},"PeriodicalIF":0.0,"publicationDate":"1998-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00095-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85677362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Current Management of Burns","authors":"MD Bradley Craft, MD Richard J. Kagan","doi":"10.1016/S1082-7579(97)00099-X","DOIUrl":"10.1016/S1082-7579(97)00099-X","url":null,"abstract":"<div><p>Major burns are relatively frequent injuries that carry a high risk for morbidity and mortality. Patients at the extremes of age or with concomitant inhalation injury are at increased risk for complications and death from their thermal injuries. The initial management of thermal injuries continues to prioritize maintenance of the airway, breathing, and circulation with prompt consideration for transfer to a specialized burn care center. Early fluid resuscitation is best accomplished with an isotonic crystalloid solution to maintain tissue perfusion, hemodynamic stability and prevent remote organ failure. The necessary fluid volume is estimated from the patient's weight and percentage of body surface area burned and adjusted as determined by the patient's clinical response. Patients who have sustained an inhalation injury are at increased risk for pneumonia and require additional fluid resuscitation, meticulous pulmonary toilet and, occasionally, mechanical ventilation. Wound care following fluid resuscitation is based on topical antimicrobial therapy followed by early surgical excision and grafting to achieve wound closure and control infection. Adequate enterai nutrition is required to minimize the loss of lean body mass. Progressive improvements in the understanding of burn shock, early wound excision and closure, the control of infection, nutritional requirements and the treatment of inhalation injuries have significantly improved the survival of burn patients in recent years.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 2","pages":"Pages 53-57"},"PeriodicalIF":0.0,"publicationDate":"1998-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00099-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75867975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MD W. Victor R. Vieweg , PhD Robin Tucker , MD Nelson L. Bernardo , PhD Linda M. Dougherty
{"title":"Mental stress and the cardiovascular system part V. Chrome mental stress and cardiovascular disease: Job stress","authors":"MD W. Victor R. Vieweg , PhD Robin Tucker , MD Nelson L. Bernardo , PhD Linda M. Dougherty","doi":"10.1016/S1082-7579(97)00098-8","DOIUrl":"10.1016/S1082-7579(97)00098-8","url":null,"abstract":"<div><p>Parameters of job stress include degree of job control and magnitude of psychological stress. These occupational characteristics may be multiplicative when low job control coexists with high psychological stress. Cardiovascular entities adversely affected by these two occupational characteristics (either alone or in combination) include hypertension, diastolic blood pressure, and coronary artery disease. Some studies challenge these hypotheses. Organism behavior may depend on both stimulus and individual capacity. Individual differences in emotional reactivity and defensiveness may relate to tension arousal and cardiovascular response to work. Enhanced tension arousal and adverse cardiovascular response may contribute to the origin and/or course of coronary artery disease. Definitive description of the relationship between job stress and cardiovascular disease awaits further large-scale studies. The influence of socioeconomic status may need to be considered to reach final resolution of this controversy. Clinicians need not wait until investigators have resolved all the controversies surrounding the relationship between job control and coronary heart disease before intervening. Behavioral strategies offer more long-term promise than simple pharmacotherapy.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 2","pages":"Pages 49-52"},"PeriodicalIF":0.0,"publicationDate":"1998-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00098-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78071097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pediatric health supervision: Birth to age two","authors":"MD Anne Kwasnik-Krawczyk","doi":"10.1016/S1082-7579(97)00100-3","DOIUrl":"10.1016/S1082-7579(97)00100-3","url":null,"abstract":"<div><p>Although medicine has historically been organized around the diagnosis and treatment of disease, this model is poorly suited to the care of children and adolescents. The periodic health examination of children provides rich opportunities for physicians to implement preventive health care strategies. Several areas of health promotion are reviewed: the use of screening examinations, educating parents through anticipatory guidance, nutritional assessment and intervention, evaluation of growth and development, psychosocial assessment, and intervention to reduce the risk of child abuse and neglect. A carefully designed flow sheet is presented as a strategy to assist the busy clinician in providing a consistent, high level of preventive care to infants and young children.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 2","pages":"Pages 34-40"},"PeriodicalIF":0.0,"publicationDate":"1998-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00100-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84035395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The toxicology of common household medications ingested by children and adolescents","authors":"DO Mary Beth Miller","doi":"10.1016/S1082-7579(97)00097-6","DOIUrl":"10.1016/S1082-7579(97)00097-6","url":null,"abstract":"<div><p>Over 1.4 million exposures reported to the American Association of Poison Centers in 1996 occurred in children under the age of nineteen. Analgesics and cough and cold preparations are the two most common groups of pharmaceutical agents reported. Studies have shown that teens are unable to correctly identify which over-the-counter remedies are potentially toxic. These facts, compounded by the wide availability of these medications, raise the level of concern for all physicians who interact with children and adolescents. This article discusses several commonly encountered medications: acetaminophen, salicylate, non-steroidal antiinflammatory agents, and anticholinergic preparations. Toxic properties and the approach to treatment are discussed so that clinicians may recognize a serious ingestion before the onset of morbidity and mortality can occur.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 2","pages":"Pages 41-44"},"PeriodicalIF":0.0,"publicationDate":"1998-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00097-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82422679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Children with chronic illness","authors":"MD Jane L. Turner","doi":"10.1016/S1082-7579(97)00096-4","DOIUrl":"10.1016/S1082-7579(97)00096-4","url":null,"abstract":"<div><p>Chronic illness is common in children. Approximately 1 child in 10 in the United States has a chronic health condition that requires frequent medical intervention and/or limits his or her activities daily most of the time. Chronic illness can have a significant impact on the child's development, growth, academic achievement, and social and psychological function. Children with chronic physical illness are at increased risk for mental illness. Family members experience psychological, social, and financial stress when a child has a chronic health condition. The child with multiple handicaps brings special challenges to families and health care professionals. Children with chronic conditions are best served when the professionals involved in their care work together.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 2","pages":"Pages 45-48"},"PeriodicalIF":0.0,"publicationDate":"1998-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00096-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73031692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}