Objective: To present a striking case of new-onset psychosis in a middle-aged woman subsequently ... more Objective: To present a striking case of new-onset psychosis in a middle-aged woman subsequently diagnosed with behavioral variant frontotemporal dementia (bvFTD). To review the data regarding key red-flag features that may suggest a diagnosis of a neurodegenerative process, and specifically bvFTD, rather than a primary psychotic disorder. To examine the role of genetics, especially mutations of the microtubule-associated protein tau (MAPT) gene, in familial cases of frontotemporal dementia (FTD). Data Sources: The pertinent literature was searched online (PubMed, Google Scholar) using the following search terms: frontotemporal dementia (FTD), Pick's disease, behavioral variant FTD (bvFTD), psychosis, delusions, MAPT, and genetics. No date or language limit was applied. Study Selection: The case report was generated through detailed assessment of clinical notes, imaging studies, and laboratory results. The brain autopsy was carried out and summarized by our neuropathology team. Previously published literature was selected for inclusion in the review section based on relevance to the topic. Results: A neurodegenerative etiology for psychosis (and specifically bvFTD) should be suspected in patients with progressive deficits in executive function, language, or memory. Other key warning features include the presence of a strong family history of a late-life psychotic disorder (or institutional placement or suicide), loss of empathy, impaired recognition of facial expression, or the development of emotional blunting and apathy, abnormal movements, or seizures. Conclusions: Neurodegenerative disease should be on the differential diagnosis for any patient presenting with new-onset psychosis and behavioral changes in mid to late adulthood. Should red-flag features be present, early referral to a clinic specializing in dementia is recommended for further evaluation. This case highlights that MAPT mutations can be associated with psychosis in FTD and should be considered in the genetic workup. Ongoing research into the cellular and neural circuit mechanisms of psychosis in neurodegenerative disease may shed light on pathologic processes underlying psychosis in primary psychiatric disorders.
The Journal of Neuropsychiatry and Clinical Neurosciences, 1989
A computer-based search was conducted to locate physicians jointly certified by the American Boar... more A computer-based search was conducted to locate physicians jointly certified by the American Board of Psychiatry and Neurology in both adult psychiatry and adult neurology since 1960. Eighty-six such physicians were found, and a survey concerning their practice patterns and opinions was conducted. From this survey, it appears that a number of "supraspecialized" neuropsychiatrists are involved in clinical activities that overlap the traditional limits of neurology and psychiatry.
Recent Advances in Diagnosis and Treatment. Advances in neuroimaging technologies. Psychopharmaco... more Recent Advances in Diagnosis and Treatment. Advances in neuroimaging technologies. Psychopharmacology in the medically ill: an update. Anesthetic management of the high-risk medical patient receiving electroconvulsive therapy. Special technical considerations in laboratory testing for illicit drugs. Advances in EEG-based diagnostic technologies. Specific Syndromes and Disease Categories. Psychiatric aspects of hematologic disorders. Human immunodeficiency virus and other infectious disorders affecting the central nervous system. Dermatology. Heart and liver transplantation. Clinical Neuropsychiatry. Diagnosis and management of patients with frontal lobe syndromes. Headache syndromes. Neuroleptic malignant syndrome: clinical presentation, pathophysiology, and treatment. Child and Adolescent Medical Psychiatry. Psychopharmacology in medically ill children and adolescents. Family therapy in the context of childhood medical illness. Pharmacotherapy of severe psychiatric disorders in men...
The Journal of Neuropsychiatry and Clinical Neurosciences, 1991
professional literature will offer the clinician both rigorously studied ap-Press, Inc. proaches ... more professional literature will offer the clinician both rigorously studied ap-Press, Inc. proaches to typical cases and thoughtfully analyzed case series and reviews JOURNAL OF NEUROPSYCHIATRY 241
Tlie depressions of late life have recently gained renewed attention as common, treatable, and of... more Tlie depressions of late life have recently gained renewed attention as common, treatable, and often undiagnosed causes of symptoms and disability in the elderly. Two groups of investigators found a 13-18 per cent prevalence of depression in large elderly community samples,'*2 and samples of geriatric medical patients reveal an even higher prevalence in elderly medical i~i p a t i e n t s .~~~ Waxman et al. demonstrated in a group of elderly volunteers that those with high scores on a self-rating depression scale had more somatic symptoms and visited general practitioners significantly more often than
General medical hospitals and freestanding psychiatric hospitals usually function independently. ... more General medical hospitals and freestanding psychiatric hospitals usually function independently. The authors review the relative strengths and weaknesses of the two settings and suggest a plan for a rational coordination of services. In an efficient integrated system, the general hospital would provide emergency psychiatric services and treat patients with combined medical and psychiatric conditions. The freestanding facility would offer inpatient and outpatient services, as well as partial hospitalization and transitional living arrangements, to psychiatric patients without medical complications. All facilities would share professional staff and data processing capabilities and would have common policies and procedures, reducing the cost of treatment and facilitating patient transfers.
What do you do to start reading family practitioners guide to treating depressive illness jt 7? S... more What do you do to start reading family practitioners guide to treating depressive illness jt 7? Searching the book that you love to read first or find an interesting book that will make you want to read? Everybody has difference with their reason of reading a book. Actuary, reading habit must be from earlier. Many people may be love to read, but not a book. It's not fault. Someone will be bored to open the thick book with small words to read. In more, this is the real condition. So do happen probably with this family practitioners guide to treating depressive illness jt 7.
Key issues examined in this first of a two-part series on the organization and development of com... more Key issues examined in this first of a two-part series on the organization and development of combined medical-psychiatric units include definition of the intended patient populations, features of the physical environment for both patients and staff, diagnostic and therapeutic capabilities, kinds of psychiatric therapy in relation to this particular therapeutic milieu, and the roles of other mental health practitioners. This evaluation, along with the subsequent discussion of associated features in Part 2, is intended to provide a comprehensive guide for assessing the feasibility of successfully operating a combined unit within a general hospital setting.
The International Journal of Psychiatry in Medicine, 1984
Integrated biopsychosocial treatment is necessary for medical patients in whom psychosocial and b... more Integrated biopsychosocial treatment is necessary for medical patients in whom psychosocial and behavioral issues strongly influence medical outcome. In this article the authors identify several large groups of such patients, and point out the limitations of three established approaches to improving their care: psychosocial education for non-psychiatrists, traditional consultation-liaison psychiatry, and ‘behavioral medicine.’ They present reasons why many of these patients would best be served by having psychiatrists as their primary physicians. Primary care of selected medical patients by psychiatrists is feasible and would improve patient care, interspecialty communication, reimbursement, and recruitment of psychiatric residents.
The purposes of this article are (1) to identify resident and facility risk factors for the use o... more The purposes of this article are (1) to identify resident and facility risk factors for the use of physical restraints since the implementation of the Nursing Home Reform Act (NHRA), and (2) to compare these results with resident and facility risk factors for the use of physical restraints prior to the implementation of the NHRA. Data were collected in 1990 and 1993, and represent residents drawn from 268 facilities in 10 states. In the 1993 cohort activities of daily living (ADL) scores, cognitive performance scale (CPS) scores, age, taking antipsychotic medications, a history of falls, and mobility problems were resident-level variables significantly associated with the use of restraints. Full-time-equivalent (FTE) nurse aides per resident, FTE RNs per resident, average occupancy, Herfindahl index, Alzheimer's special care unit, and Medicaid reimbursement policy were facility-level variables significantly associated with the use of restraints. When the 1990 cohort was compared to the 1993 cohort (pre- and post-NHRA), however, only three risk factors for the use of restraints were significant. We propose that, to date, the NHRA may have been successful in reducing the use of physical restraints, but it appears to have had less impact on the types of residents who are restrained.
Objective: To present a striking case of new-onset psychosis in a middle-aged woman subsequently ... more Objective: To present a striking case of new-onset psychosis in a middle-aged woman subsequently diagnosed with behavioral variant frontotemporal dementia (bvFTD). To review the data regarding key red-flag features that may suggest a diagnosis of a neurodegenerative process, and specifically bvFTD, rather than a primary psychotic disorder. To examine the role of genetics, especially mutations of the microtubule-associated protein tau (MAPT) gene, in familial cases of frontotemporal dementia (FTD). Data Sources: The pertinent literature was searched online (PubMed, Google Scholar) using the following search terms: frontotemporal dementia (FTD), Pick's disease, behavioral variant FTD (bvFTD), psychosis, delusions, MAPT, and genetics. No date or language limit was applied. Study Selection: The case report was generated through detailed assessment of clinical notes, imaging studies, and laboratory results. The brain autopsy was carried out and summarized by our neuropathology team. Previously published literature was selected for inclusion in the review section based on relevance to the topic. Results: A neurodegenerative etiology for psychosis (and specifically bvFTD) should be suspected in patients with progressive deficits in executive function, language, or memory. Other key warning features include the presence of a strong family history of a late-life psychotic disorder (or institutional placement or suicide), loss of empathy, impaired recognition of facial expression, or the development of emotional blunting and apathy, abnormal movements, or seizures. Conclusions: Neurodegenerative disease should be on the differential diagnosis for any patient presenting with new-onset psychosis and behavioral changes in mid to late adulthood. Should red-flag features be present, early referral to a clinic specializing in dementia is recommended for further evaluation. This case highlights that MAPT mutations can be associated with psychosis in FTD and should be considered in the genetic workup. Ongoing research into the cellular and neural circuit mechanisms of psychosis in neurodegenerative disease may shed light on pathologic processes underlying psychosis in primary psychiatric disorders.
The Journal of Neuropsychiatry and Clinical Neurosciences, 1989
A computer-based search was conducted to locate physicians jointly certified by the American Boar... more A computer-based search was conducted to locate physicians jointly certified by the American Board of Psychiatry and Neurology in both adult psychiatry and adult neurology since 1960. Eighty-six such physicians were found, and a survey concerning their practice patterns and opinions was conducted. From this survey, it appears that a number of "supraspecialized" neuropsychiatrists are involved in clinical activities that overlap the traditional limits of neurology and psychiatry.
Recent Advances in Diagnosis and Treatment. Advances in neuroimaging technologies. Psychopharmaco... more Recent Advances in Diagnosis and Treatment. Advances in neuroimaging technologies. Psychopharmacology in the medically ill: an update. Anesthetic management of the high-risk medical patient receiving electroconvulsive therapy. Special technical considerations in laboratory testing for illicit drugs. Advances in EEG-based diagnostic technologies. Specific Syndromes and Disease Categories. Psychiatric aspects of hematologic disorders. Human immunodeficiency virus and other infectious disorders affecting the central nervous system. Dermatology. Heart and liver transplantation. Clinical Neuropsychiatry. Diagnosis and management of patients with frontal lobe syndromes. Headache syndromes. Neuroleptic malignant syndrome: clinical presentation, pathophysiology, and treatment. Child and Adolescent Medical Psychiatry. Psychopharmacology in medically ill children and adolescents. Family therapy in the context of childhood medical illness. Pharmacotherapy of severe psychiatric disorders in men...
The Journal of Neuropsychiatry and Clinical Neurosciences, 1991
professional literature will offer the clinician both rigorously studied ap-Press, Inc. proaches ... more professional literature will offer the clinician both rigorously studied ap-Press, Inc. proaches to typical cases and thoughtfully analyzed case series and reviews JOURNAL OF NEUROPSYCHIATRY 241
Tlie depressions of late life have recently gained renewed attention as common, treatable, and of... more Tlie depressions of late life have recently gained renewed attention as common, treatable, and often undiagnosed causes of symptoms and disability in the elderly. Two groups of investigators found a 13-18 per cent prevalence of depression in large elderly community samples,'*2 and samples of geriatric medical patients reveal an even higher prevalence in elderly medical i~i p a t i e n t s .~~~ Waxman et al. demonstrated in a group of elderly volunteers that those with high scores on a self-rating depression scale had more somatic symptoms and visited general practitioners significantly more often than
General medical hospitals and freestanding psychiatric hospitals usually function independently. ... more General medical hospitals and freestanding psychiatric hospitals usually function independently. The authors review the relative strengths and weaknesses of the two settings and suggest a plan for a rational coordination of services. In an efficient integrated system, the general hospital would provide emergency psychiatric services and treat patients with combined medical and psychiatric conditions. The freestanding facility would offer inpatient and outpatient services, as well as partial hospitalization and transitional living arrangements, to psychiatric patients without medical complications. All facilities would share professional staff and data processing capabilities and would have common policies and procedures, reducing the cost of treatment and facilitating patient transfers.
What do you do to start reading family practitioners guide to treating depressive illness jt 7? S... more What do you do to start reading family practitioners guide to treating depressive illness jt 7? Searching the book that you love to read first or find an interesting book that will make you want to read? Everybody has difference with their reason of reading a book. Actuary, reading habit must be from earlier. Many people may be love to read, but not a book. It's not fault. Someone will be bored to open the thick book with small words to read. In more, this is the real condition. So do happen probably with this family practitioners guide to treating depressive illness jt 7.
Key issues examined in this first of a two-part series on the organization and development of com... more Key issues examined in this first of a two-part series on the organization and development of combined medical-psychiatric units include definition of the intended patient populations, features of the physical environment for both patients and staff, diagnostic and therapeutic capabilities, kinds of psychiatric therapy in relation to this particular therapeutic milieu, and the roles of other mental health practitioners. This evaluation, along with the subsequent discussion of associated features in Part 2, is intended to provide a comprehensive guide for assessing the feasibility of successfully operating a combined unit within a general hospital setting.
The International Journal of Psychiatry in Medicine, 1984
Integrated biopsychosocial treatment is necessary for medical patients in whom psychosocial and b... more Integrated biopsychosocial treatment is necessary for medical patients in whom psychosocial and behavioral issues strongly influence medical outcome. In this article the authors identify several large groups of such patients, and point out the limitations of three established approaches to improving their care: psychosocial education for non-psychiatrists, traditional consultation-liaison psychiatry, and ‘behavioral medicine.’ They present reasons why many of these patients would best be served by having psychiatrists as their primary physicians. Primary care of selected medical patients by psychiatrists is feasible and would improve patient care, interspecialty communication, reimbursement, and recruitment of psychiatric residents.
The purposes of this article are (1) to identify resident and facility risk factors for the use o... more The purposes of this article are (1) to identify resident and facility risk factors for the use of physical restraints since the implementation of the Nursing Home Reform Act (NHRA), and (2) to compare these results with resident and facility risk factors for the use of physical restraints prior to the implementation of the NHRA. Data were collected in 1990 and 1993, and represent residents drawn from 268 facilities in 10 states. In the 1993 cohort activities of daily living (ADL) scores, cognitive performance scale (CPS) scores, age, taking antipsychotic medications, a history of falls, and mobility problems were resident-level variables significantly associated with the use of restraints. Full-time-equivalent (FTE) nurse aides per resident, FTE RNs per resident, average occupancy, Herfindahl index, Alzheimer's special care unit, and Medicaid reimbursement policy were facility-level variables significantly associated with the use of restraints. When the 1990 cohort was compared to the 1993 cohort (pre- and post-NHRA), however, only three risk factors for the use of restraints were significant. We propose that, to date, the NHRA may have been successful in reducing the use of physical restraints, but it appears to have had less impact on the types of residents who are restrained.
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