Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Psychopharmaologic intervention for elderly patients requires careful considerations for physical characteristics, comorbid medical illness, and interaction between drugs for psychotropic and somatic diseases drugs. Elderly patients often suffer from depression, delirium, and dementia, which occasionally coexist with each other. Antidepressants, antipsychotics, anxiolytics and hypnotics are prescribed according to the targeted psychiatric symptoms. Drug effect tens to be strengthened and prolonged pharmacodynamically in elderly patients because of decline of drug clearance in liver and kidney, prolongation of elimination half life of lipophilic drug resulted from reduced muscle tissue, and elevated free serum drug level induced by low albuminemia. Elderly patients pharmacokinetically develop adverse effects in relatively lower serum drug level. Lower initial dose and slow titration should be strongly recommended. Cerebrovascular disease and neurodegerative disease are frequently observed among elderly patients. Significant number of patients with cerebrovascular disease are complicated with depression, delirium, and in lower prevalence, dementia. Although drugs used in acute phase stroke have no pharmacodynamic interaction with psychotropics, many patients be carefully titrated with continuous monitoring of PT-INR during concurrent use of tricyclic antidepressants and selective serotonin reuptake inhibitors. Alzheimer's disease and Parkinson's disease are highly prevalent and clinically important neurodegerative disease in elderly population. Patients with Alzheimer's disease frequently exhibit delirium soon after hospitalization, which necessitates appropriate pharmacotherapy with psychotropics. After Food and Drug Foundation warned against antipsychotic use for patients with dementia, this off-label use are considered to be avoided but disease frequently coincide with depression and receive antidepressant treatment. If selegiline id prescribed, antidepressants cannot be initiated without discontinuation of selegiline. When delirium develops in patients with Parkinson's disease, second generation antipsychotics such as quetiapine are firstly administered with caution for deterioration of motor symptoms.
 ...
PMID:[Clinical issues on prescribing psychotropics for elderly patients]. 2309 91

Psychiatric disorders (PDs) in neurology are more frequent then it verified in routine exam, not only in the less developed but also in large and very developed neurological departments. Furthermore, psychiatric symptoms (PSs) in neurological disorders (NDs) among primary health care physicians and other specialties are often neglected. Anxiety and depression are most common, but hallucinations, delusions, obsessive-compulsive disorder and delirium or confusional state are also frequent comorbidity in many neurological conditions such as stroke, epilepsy, multiple sclerosis (MS), Parkinson disease (PD). Depression and NDs also have a bidirectional relationship, as not only are patients, for example with stroke at greater risk of developing depression, but patients with depression have a two-fold greater risk of developing a stroke, even after controlling for other risk factors. Dementia or cognitive impairment are part of clinical picture of PD, stroke patients, patients with MS, Huntington disease etc. The prototype of dementia in PD and other NDs is a dysexecutive syndrome with impaired attention, executive functions and secondarily impaired memory. So-called "functional" (or psychogenic or hysterical/conversion) symptoms are relatively infrequent in "neurological" conditions, but very often unrecognized and not properly treated. Treatment of PSs in neurology, basically are not different then treatment of these symptoms in psychiatry and should be include pharmacotherapy and psychiatry. This presentation gives an overview of frequency and type of PSs underlying necessity to recognize these disorders in every day routine exam and properly treatment.
 ...
PMID:Psychiatric disorders in neurology. 2311 12

Contributions from the neurosciences to Critical Care in 2011 covered an array of topics. We learned about potential biomarkers for, and the effect of cerebral oxygen metabolism on, delirium, in addition to treatment of the latter. A group of investigators studied surface cooling in healthy awake volunteers, and incidence of infection associated with therapeutic hypothermia. The effects of statin and erythropoietin on stroke were revisited, and the role of adhesion molecule in the inflammatory reaction accompanying intracerebral hemorrhage was scrutinized. Biomarkers in subarachnoid hemorrhage and their relationship to vasospasm and outcome, and effect of daylight on outcome in this patient population, as well as a new meta-analysis of statin therapy were among the research in subarachnoid hemorrhage. Moreover, 2011 witnessed the publication of a multidisciplinary consensus conference's recommendations on the critical care management of subarachnoid hemorrhage. Results of studies regarding the diagnosis and vascular complications of meningitis were reported. Traumatic brain injury received its share of articles addressing therapy with hypertonic saline and surgical decompression, the development of coagulopathy, and biomarkers to help with prognostication. Finally, research on the treatment of Guillain-Barre syndrome in children, prediction of long-term need of ventilatory support, and pathophysiology of critical illness polyneuropathy and myopathy were reported.
...
PMID:Year in review 2011: Critical Care--Neurocritical care. 2325 71

We report a case of a female patient with Durie-Salmon stage 3A/ISS stage I IgG kappa multiple myeloma (MM) who developed encephalopathy after high-dose melphalan and hematopoietic stem cell transplant (HSCT). The most common etiologies for encephalopathy such as infection, narcotic medications, metabolic-electrolyte disturbance, stroke, and central nervous system (CNS) hemorrhages were ruled out. The patient recovered from the altered mental status spontaneously. The possibilities of melphalan-induced encephalopathy versus critical-state delirium versus hypercytokinemia induce encephalopathy were contemplated.
 ...
PMID:Melphalan Culprit or Confounder in Acute Encephalopathy during Autologous Hematopoietic Stem Cell Transplantation? 2325 45

Delirium is a common complication of stroke worsening its prognosis. In this work we have analyzed the frequency of delirium and factors, predisposing to its development in the population of Russian patients in hyperacute phase of stroke. Twenty two of 96 (around 23%) recruited patients revealed symptoms of delirium according to DSM-IV criteria. Patients of older age, those with severe stroke, with prominent chronic cerebral changes on brain CAT scan, with fever, those with urine catheter and with positive snout reflex were more likely to develop delirium. Severity of posterior leucoareosis was the only independent predictor of delirium according to multivariate analysis.
 ...
PMID:[Delirium in the acute phase of stroke: frequency and predisposing factors]. 2361 97

Symptom control for hospice patients frequently involves the use of pharmacologic agents for control of pain, dyspnea, and anxiety. Other troubling symptoms that will often require pharmacologic agents include nausea, vomiting, constipation, and delirium. While the Medicare requirement for hospice is a prognosis of six months or less, accurately predicting prognosis is very difficult. Because of this, medications for symptom control will often have to be prescribed and refilled without knowing exactly how much the hospice patient may require. The objective of the current study was to determine the amount of medication discarded at death. Additionally we wanted to estimate the cost related to discarded medication. We reviewed the records of 296 patients over a three-year period in a community hospice to characterize the medications that were discarded at death. Seventeen patients were not eligible for evaluation because of lack of complete information, leaving 279 study subjects. Cost calculations were used using a website cost calculator (HealthTrans.com). Fifty-six percent of the decedents were female and the majority were Hispanic (62%). The five most common diagnoses were cancer (36%); dementia (22%); and COPD, CVA, and congestive heart failure (CHF) (8%). The median length of stay in hospice was 16 days. The most frequent medication unused at the time of death was morphine solution followed by lorazepam. The cost of discarded morphine including tablets as well as solution totaled over $6,000 for the study period. The next highest medication cost was lorazepam for both solution and tablets, which came to over $1,600. The total estimated cost for all medications for the study period amounted to $14,980. The results of this study indicate that hospice patients have variable amounts of discarded medication at the time of death and that the cost involved of these unused medications can be significant. Hospice organizations should investigate creative ways to reduce the amount of discarded medications.
 ...
PMID:Costs and implications of discarded medication in hospice. 2380 30

Herpes simplex encephalitis (HSE) still remains a serious illness with high morbidity and mortality. The characteristic presentation of HSE usually consists of fever, headache, and altered mental function. We present three patients with atypical features of HSE. First, a 48-year-old man with symptomatic posttraumatic epilepsy, who developed a gastrointestinal infection, seizures, and fever. After significant clinical improvement, the patient had fever again and developed a status epilepticus, which led to the diagnosis of HSE. Second, an 84-year-old woman with hyperactive delirium after levofloxacin intake. Cranial computed tomography (CCT) revealed hypodense temporal changes, prompting lumbar puncture and diagnosis of HSE. Third, a 51-year-old diabetic woman presented with fever and acute confusion. As CCT and cell count of cerebrospinal fluid (CSF) were normal, infection and hyperglycemia as initial diagnoses were postulated. Due to aphasic symptoms, the differential diagnosis of a stroke was taken into account. Thus a second lumbar puncture led to the correct diagnosis of HSE. These atypical presentations need a high grade of suspicion and a high willingness to reconsider the initial working diagnosis, in order to prevent a diagnostic delay.
...
PMID:Pitfalls associated with the diagnosis of herpes simplex encephalitis. 2391 95

Cerebral dysfunction after cardiac surgery remains a devastating complication and is growing in importance with our aging populations. Neurological complications following cardiac surgery can be classified broadly as stroke, encephalopathy (including delirium), or postoperative cognitive dysfunction (POCD). These etiologies are caused primary by cerebral emboli, hypoperfusion, or inflammation that has largely been attributed to the use of cardiopulmonary bypass. Preventative operative strategies, such as off-pump coronary artery bypass grafting (CABG), can potentially reduce the incidence of postoperative neurological complications by avoiding manipulation of the ascending aorta. Although off-pump CABG is associated with reduced risk of stroke, there are no convincing differences in POCD between off-pump and on-pump CABG. Recently, the focus of postoperative neurological research has shifted from managing cardiopulmonary bypass to patient-related factors. Identifying changes in brains of aged individuals undergoing cardiac surgery may improve strategies for preventing cerebral dysfunction. Advanced age is associated with more undiagnosed cerebrovascular disease and is a major risk factor for stroke and POCD following cardiac surgery. Preoperative cerebrovascular evaluation and adaptation of surgical strategies will provide preventative approaches for cerebral dysfunction after CABG. This review focuses on recent findings of the relationship between perioperative stress and underlying fragility of the brain in cardiac surgical patients.
...
PMID:Cerebral dysfunction after coronary artery bypass surgery. 2398 56

The article describes current scientific views on the predictors of neurological complications caused by coronary artery bypass grafting (CABG) surgery. The authors present the results of the study clarifying the most important predictors of stroke and postoperative delirium. The predictive value of preoperative data of neuropsychological testing in the identification of risk factors for postoperative long-term cognitive decline in patients undergoing CABG has been shown.
...
PMID:[Predictors of neurological complications in patients undergoing coronary artery bypass grafting]. 2399 38

The aim of our retrospective study was to investigate the efficacy and safety of Yokukansan(TJ-54)in treating delirium during hospitalization following acute stroke. We retrospectively analyzed the patients 1)who were admitted to our single stroke center from January 2010 to December 2011 due to acute stroke within four days from onset, 2)who presented with delirium after admission, which was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision(DSM-IV-TR)criteria, and 3)who received 2.5g of Yokukansan(TJ-54)three times a day for treating delirium and which was continued until discharge or until onset of adverse effects. We investigated the patient's baseline characteristics, the period of Yokukansan treatment, history of using of another psychotropic drug and complications. We used the Delirium Rating Scale(DRS)to assess delirium state before and at five days after initiation of Yokukansan(TJ-54). We analyzed 77 patients retrospectively. Their mean age was 79.3 years old, and 48 patients(62%)were female. Median DRS score was improved from 15(interquartile range;14-18)to 8(interquartile;6-13), statistically significant(p<0.01)at five days after the initiation of Yokukansan(TJ-54). The median period of Yokukansan(TJ-54)treatment was seven days. There were no patients who received psychotropic drugs or who were suspected of developing oversedation due to Yokukansan(TJ-54). In our study, delirium symptoms following acute stroke improved after Yokukansan(TJ-54)treatment. A randomized controlled trial is needed to establish the effectiveness of Yokukansan(TJ-54)in delirium after stroke.
...
PMID:[Retrospective analysis of the effectiveness of Yokukansan(Japanese Herbal Medicine, TJ-54)in the treatment of delirium following acute stroke]. 2401 83


<< Previous 1 2 3 4 5 6 7 8 9 10