Joseph Kass | Baylor College of Medicine (original) (raw)
Papers by Joseph Kass
Alzheimers & Dementia, Jul 1, 2017
studies compare NPS ofMCI between Taiwanese andWestern samples. Methods:This was a cross-sectiona... more studies compare NPS ofMCI between Taiwanese andWestern samples. Methods:This was a cross-sectional study. A total of 268 participants were recruited from the outpatient clinics of two hospitals in Northern Taiwan from 2007-2011. A total of 249 participants completed the cognitive and neuropsychiatric evaluations, including 90 normal controls (NC) and 159 MCI subjects. The MCI criteria followed Petersen criteria except with more stringent requirement that the neurocognitive impairment had to be 4% below mean of norm. The Neuropsychiatric Inventory (NPI) was used to assess the NPS. The prevalence of each neuropsychiatric symptoms was compared between our study and previous studies. Results: The prevalence of at least one NPS in MCI group was 54.7%. Four of the most prevalent neuropsychiatric symptoms in MCI were night-time behavior disturbances (22.0%), apathy (20.1%), irritability (16.4%) and depression (14.5%). When compared with Western studies (including clinical MCI and population-based MCI samples), the prevalence of NPS in our clinical sample was more similar to that of population-based samples, but less than that of clinical sample from Western countries. Conclusions:Our findings suggest the prevalence of NPS in Taiwanese clinical MCI sample is more similar to that of population-based samples, rather than clinical samples, in Western studies. It could be related to easy accessibility to hospitals in Taiwan. Our results are also consistent with previous epidemiological studies in Taiwan showing lower prevalence of depression and anxiety by non-physician interviewers when compared with Western studies.
Fundamentals of HIV Medicine 2021
This chapter delineates the clinical features, differential diagnosis, and management of HIV-asso... more This chapter delineates the clinical features, differential diagnosis, and management of HIV-associated neurocognitive disorders (HAND). Learners will understand the high prevalence of HAND in antiretroviral-naive patients and among patents with virologic suppression. Information is given about how to use rapid screening tools such as the Montreal Cognitive Assessment (MOCA) test and Frontal Assessment Battery (FAB) test to diagnose HAND in the clinic. The learner will also examine other significant cognitive, behavioral, and motor abnormalities that impact HIV compliance, retention in care for older individuals, and quality of life.
Communications Medicine
Background Alzheimer’s disease, the most common cause of dementia, causes a progressive and irrev... more Background Alzheimer’s disease, the most common cause of dementia, causes a progressive and irreversible deterioration of cognition that can sometimes be difficult to diagnose, leading to suboptimal patient care. Methods We developed a predictive model that computes multi-regional statistical morpho-functional mesoscopic traits from T1-weighted MRI scans, with or without cognitive scores. For each patient, a biomarker called “Alzheimer’s Predictive Vector” (ApV) was derived using a two-stage least absolute shrinkage and selection operator (LASSO). Results The ApV reliably discriminates between people with (ADrp) and without (nADrp) Alzheimer’s related pathologies (98% and 81% accuracy between ADrp - including the early form, mild cognitive impairment - and nADrp in internal and external hold-out test sets, respectively), without any a priori assumptions or need for neuroradiology reads. The new test is superior to standard hippocampal atrophy (26% accuracy) and cerebrospinal fluid b...
Fundamentals of HIV Medicine 2019, 2019
Discuss the clinical features, differential diagnosis, and management of HIV-associated neurocogn... more Discuss the clinical features, differential diagnosis, and management of HIV-associated neurocognitive disorders. • CD8+ T cell encephalitis has been described as a severe form of HIV-associated neurocognitive disorder (HAND). • The central nervous system (CNS) penetration effectiveness score has been correlated with cerebrospinal fluid (CSF) viral escape....
Neurology, 2017
Objective: To describe a rare presentation of aphemia with a left inferior frontal gyrus infarct ... more Objective: To describe a rare presentation of aphemia with a left inferior frontal gyrus infarct involving cortical and subcortical regions. Background: Stroke-related aphemia should be considered in the differential of acute loss of voluntary oral control resulting in loss of speech output with preserved comprehension and written communication. Design/Methods: A case report Results: A 43 year-old right handed female with untreated diabetes and hypertension presented with acute onset of loss of ability to speak and eat. Exam demonstrated a mild right lower facial droop, an inability to open the mouth, stick out the tongue, purse lips, voluntarily swallow, and spontaneously vocalize. Comprehension was intact and writing was fluent. MRI brain revealed an acute ischemic infarct of the left inferior frontal gyrus extending to the corona radiata. With speech therapy she experienced slow improvement and was discharged on a regular diet, able to vocalize simple words. Conclusions: Aphemia,...
Journal of the Neurological Sciences, 2013
Background: It has been shown that patients with type 2 diabetes mellitus (T2DM) exhibit altered ... more Background: It has been shown that patients with type 2 diabetes mellitus (T2DM) exhibit altered autonomic activity of cardiovascular system. Objective: The current study aimed to compare cardiovascular autonomic function between the healthy offsprings with and without parental history of T2DM. Material and methods: Heart rate variability (HRV) and cardiovascular autonomic reactivity of 80 healthy male subjects, between the age group of 18 and 30 years were assessed. The study group consisted of 40 subjects with parental history of T2DM and control group included 40 subjects without parental history of diabetes. HRV was assessed by fast Fourier transformation of supine 5 min ECG epoch recorded at spontaneous respiratory rates. Cardiovascular autonomic reactivity was assessed by deep breathing, Valsalva maneuver, handgrip and head up tilt. Results: In HRV, all the time domain measures which are the markers of parasympathetic activity were comparable. In frequency domain measures, low frequency (LF) which is the marker of sympathetic activity and high frequency (HF) which is the marker of parasympathetic activity as well as LF/HF which is the sympathovagal balance were comparable. Among autonomic reactivity variables, deep breathing and Valsalva ratio which are the markers of parasympathetic reactivity were comparable. Similarly, rise in diastolic blood pressure during handgrip and change in systolic blood pressure in head up tilt which are the markers of sympathetic reactivity were also comparable. Conclusion: This study concludes that the parental history of diabetes does not have an impact on cardiovascular autonomic function in offsprings between the age group of 18 and 30 years.
Stroke
Introduction: While the goal of IV tissue plasminogen activator (TPA) is to prevent infarction, f... more Introduction: While the goal of IV tissue plasminogen activator (TPA) is to prevent infarction, few data exist on averted stroke. Methods: Secondary analysis of a multicenter trial from 2014-2020 comparing outcomes between patients treated for stroke by mobile stroke unit (MSU) vs standard care (SC). The analytical cohort were patients with suspected stroke treated with IV TPA. The primary outcome was a time-defined averted stroke diagnosis, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours. The secondary outcome was a tissue-defined averted stroke diagnosis, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours and no acute infarction/hemorrhage on imaging. We used multivariable logistic regression to evaluate associations between study exposures (demographics, comorbidities, stroke characteristics) and outcomes. Results: Among 1009 patients with a median last known well-to-TPA time of 87 minute...
CONTINUUM: Lifelong Learning in Neurology, 2020
Rapid eye movement (REM) sleep behavior disorder (RBD) may result in a patient injuring a bed par... more Rapid eye movement (REM) sleep behavior disorder (RBD) may result in a patient injuring a bed partner while acting out a dream. This article examines the complexities associated with RBD as a criminal defense strategy as well as the legal implications for physicians and their duty to patients and their families to mitigate risks associated with possible injuries related to RBD.
Tienda online donde Comprar Neurology Secrets (Online And Print) 6th Ed. al precio 3687,60 € de J... more Tienda online donde Comprar Neurology Secrets (Online And Print) 6th Ed. al precio 3687,60 € de Joseph S. Kass | Eli M. Mizrahi, tienda de Libros de Medicina, Libros de Neurologia - Neurologia general
Neurology, 2014
OBJECTIVE: To determine the feasibility of mentored peer review as an educational tool for teachi... more OBJECTIVE: To determine the feasibility of mentored peer review as an educational tool for teaching neurology residents fundamental principles of biostatistics, research methodology, and peer review. BACKGROUND: Learning to appraise scientific literature critically and apply this skill to clinical practice is an ACGME core competency or milestone, Practice-Based Learning and Improvement. Innovative approaches to such instruction are lacking in neurology training. DESIGN/METHODS: A partially-blinded, randomized, controlled multi-center pilot study of mentored peer review recruited PGY-3 and PGY-4 neurology residents from nine training programs. Five standardized manuscripts with introduced errors were distributed at two month intervals and reviews written by trainees were graded by blinded assessment using a validated instrument, the Review Quality Instrument (RQI). Residents were randomized to receive either unstructured faculty mentoring on peer review or no mentoring. Primary outc...
Journal of Alzheimer's Disease, 2021
Longitudinal observational cohort studies are being conducted worldwide to understand cognition, ... more Longitudinal observational cohort studies are being conducted worldwide to understand cognition, biomarkers, and the health of the aging population better. Cross-cohort comparisons and networks of registries in Alzheimer’s disease (AD) foster scientific exchange, generate insights, and contribute to the evolving clinical science in AD. A scientific working group was convened with invited investigators from established cohort studies in AD, in order to form a research collaboration network as a resource to address important research questions. The Connecting Cohorts to Diminish Alzheimer’s Disease (CONCORD-AD) collaboration network was created to bring together global resources and expertise, to generate insights and improve understanding of the natural history of AD, to inform design of clinical trials in all disease stages, and to plan for optimal patient access to disease-modifying therapies once they become available. The network brings together expertise and data insights from 7...
Alzheimer's & Dementia, 2018
Compared to scoring 1, scoring 5 on the ADFlag scale conveyed a 19.66-fold increase (15.98-24.18;... more Compared to scoring 1, scoring 5 on the ADFlag scale conveyed a 19.66-fold increase (15.98-24.18; Chisq<0.0001) in the odds for incipient AD diagnostic by A+T+N+ criteria, and scoring 4 a 2.96-fold increase (2.62-3.33; Chisq<0.0001). Patients scoring 5 on the ADFlag scale were all part of the Alzheimer’s pathophysiologic continuum (A+). Together, patients scoring either 4 or 5 represented 73% of all A+ patients, including 63.63% of the A+T+N+ or A+T+N(incipient AD). Moreover, we found that an ADFlag score of 4 at baseline significantly increased the odds for conversion 4.17-fold compared to patients scoring 1 (3.61-4.80; Chisq<0.0001) and 8.34-fold compared to patients scoring 3 (6.37-10.91; Chisq<0.0001). A generalized regression predictive model confirmed the association between conversion to AD and scoring 4 on the ADFlag scale. Conclusions: ADFlag has significant prognostic value and it’s use as a stratification tool to prescreen aMCI patients into preventive or therapeutic trials may enhance their chance of success.
Alzheimer's & Dementia, 2017
Continuum (Minneapolis, Minn.), 2016
This article presents a case in which a neurology group practice is considering investing in an i... more This article presents a case in which a neurology group practice is considering investing in an imaging center that is owned by nonphysician investors with the aim of referring patients to this imaging center. The article reviews some important legal pitfalls in federal law that physicians must be aware of when considering such an investment and focuses on the general outlines of and exceptions to the Stark Law and the Federal Anti-Kickback Statute.
Oxford Medicine Online, 2017
HIV causes a chronic form of encephalitis (HIVE) that is clinically characterized by either demen... more HIV causes a chronic form of encephalitis (HIVE) that is clinically characterized by either dementia or mild neurocognitive impairment. Since the introduction of antiretroviral therapy in 1996, the incidence of HIV dementia has decreased by 50%, but the prevalence of mild neurocognitive disorder has increased up to 39%. HIVE is the result of direct microglial infection, interruption of trophic factors, or caused by inflammatory cytokines. HIV enters the brain primarily by the “Trojan horse mechanism”; it is carried by monocytes and lymphocytes that cross the blood–brain barrier. HIV has a predilection for the basal ganglia, deep white matter, and hippocampus, resulting in a subcortical dementia. HIV dementia is a diagnosis of exclusion and other co-infections, cerebrovascular disease, malnutrition, and drug abuse should be ruled out before making the diagnosis. In patients receiving antiretroviral therapy with immunological response, a novel condition termed CD8+ T cell encephalitis...
CONTINUUM: Lifelong Learning in Neurology, 2015
Regardless of their specialty, physicians encounter various potential clinical emergencies in the... more Regardless of their specialty, physicians encounter various potential clinical emergencies in their outpatients that may require referring patients for the appropriate level and urgency of care. One such situation is the outpatient who presents with suicidal or homicidal ideation. In this circumstance, the physician is faced with performing a rapid evaluation of the symptoms, determining the acuity of the situation, and safely referring the patient to an appropriate level of care. Using case vignettes, this article reviews some of the immediate critical factors to consider in evaluating and managing the outpatient who expresses thoughts of suicide or homicide.
Alzheimers & Dementia, Jul 1, 2017
studies compare NPS ofMCI between Taiwanese andWestern samples. Methods:This was a cross-sectiona... more studies compare NPS ofMCI between Taiwanese andWestern samples. Methods:This was a cross-sectional study. A total of 268 participants were recruited from the outpatient clinics of two hospitals in Northern Taiwan from 2007-2011. A total of 249 participants completed the cognitive and neuropsychiatric evaluations, including 90 normal controls (NC) and 159 MCI subjects. The MCI criteria followed Petersen criteria except with more stringent requirement that the neurocognitive impairment had to be 4% below mean of norm. The Neuropsychiatric Inventory (NPI) was used to assess the NPS. The prevalence of each neuropsychiatric symptoms was compared between our study and previous studies. Results: The prevalence of at least one NPS in MCI group was 54.7%. Four of the most prevalent neuropsychiatric symptoms in MCI were night-time behavior disturbances (22.0%), apathy (20.1%), irritability (16.4%) and depression (14.5%). When compared with Western studies (including clinical MCI and population-based MCI samples), the prevalence of NPS in our clinical sample was more similar to that of population-based samples, but less than that of clinical sample from Western countries. Conclusions:Our findings suggest the prevalence of NPS in Taiwanese clinical MCI sample is more similar to that of population-based samples, rather than clinical samples, in Western studies. It could be related to easy accessibility to hospitals in Taiwan. Our results are also consistent with previous epidemiological studies in Taiwan showing lower prevalence of depression and anxiety by non-physician interviewers when compared with Western studies.
Fundamentals of HIV Medicine 2021
This chapter delineates the clinical features, differential diagnosis, and management of HIV-asso... more This chapter delineates the clinical features, differential diagnosis, and management of HIV-associated neurocognitive disorders (HAND). Learners will understand the high prevalence of HAND in antiretroviral-naive patients and among patents with virologic suppression. Information is given about how to use rapid screening tools such as the Montreal Cognitive Assessment (MOCA) test and Frontal Assessment Battery (FAB) test to diagnose HAND in the clinic. The learner will also examine other significant cognitive, behavioral, and motor abnormalities that impact HIV compliance, retention in care for older individuals, and quality of life.
Communications Medicine
Background Alzheimer’s disease, the most common cause of dementia, causes a progressive and irrev... more Background Alzheimer’s disease, the most common cause of dementia, causes a progressive and irreversible deterioration of cognition that can sometimes be difficult to diagnose, leading to suboptimal patient care. Methods We developed a predictive model that computes multi-regional statistical morpho-functional mesoscopic traits from T1-weighted MRI scans, with or without cognitive scores. For each patient, a biomarker called “Alzheimer’s Predictive Vector” (ApV) was derived using a two-stage least absolute shrinkage and selection operator (LASSO). Results The ApV reliably discriminates between people with (ADrp) and without (nADrp) Alzheimer’s related pathologies (98% and 81% accuracy between ADrp - including the early form, mild cognitive impairment - and nADrp in internal and external hold-out test sets, respectively), without any a priori assumptions or need for neuroradiology reads. The new test is superior to standard hippocampal atrophy (26% accuracy) and cerebrospinal fluid b...
Fundamentals of HIV Medicine 2019, 2019
Discuss the clinical features, differential diagnosis, and management of HIV-associated neurocogn... more Discuss the clinical features, differential diagnosis, and management of HIV-associated neurocognitive disorders. • CD8+ T cell encephalitis has been described as a severe form of HIV-associated neurocognitive disorder (HAND). • The central nervous system (CNS) penetration effectiveness score has been correlated with cerebrospinal fluid (CSF) viral escape....
Neurology, 2017
Objective: To describe a rare presentation of aphemia with a left inferior frontal gyrus infarct ... more Objective: To describe a rare presentation of aphemia with a left inferior frontal gyrus infarct involving cortical and subcortical regions. Background: Stroke-related aphemia should be considered in the differential of acute loss of voluntary oral control resulting in loss of speech output with preserved comprehension and written communication. Design/Methods: A case report Results: A 43 year-old right handed female with untreated diabetes and hypertension presented with acute onset of loss of ability to speak and eat. Exam demonstrated a mild right lower facial droop, an inability to open the mouth, stick out the tongue, purse lips, voluntarily swallow, and spontaneously vocalize. Comprehension was intact and writing was fluent. MRI brain revealed an acute ischemic infarct of the left inferior frontal gyrus extending to the corona radiata. With speech therapy she experienced slow improvement and was discharged on a regular diet, able to vocalize simple words. Conclusions: Aphemia,...
Journal of the Neurological Sciences, 2013
Background: It has been shown that patients with type 2 diabetes mellitus (T2DM) exhibit altered ... more Background: It has been shown that patients with type 2 diabetes mellitus (T2DM) exhibit altered autonomic activity of cardiovascular system. Objective: The current study aimed to compare cardiovascular autonomic function between the healthy offsprings with and without parental history of T2DM. Material and methods: Heart rate variability (HRV) and cardiovascular autonomic reactivity of 80 healthy male subjects, between the age group of 18 and 30 years were assessed. The study group consisted of 40 subjects with parental history of T2DM and control group included 40 subjects without parental history of diabetes. HRV was assessed by fast Fourier transformation of supine 5 min ECG epoch recorded at spontaneous respiratory rates. Cardiovascular autonomic reactivity was assessed by deep breathing, Valsalva maneuver, handgrip and head up tilt. Results: In HRV, all the time domain measures which are the markers of parasympathetic activity were comparable. In frequency domain measures, low frequency (LF) which is the marker of sympathetic activity and high frequency (HF) which is the marker of parasympathetic activity as well as LF/HF which is the sympathovagal balance were comparable. Among autonomic reactivity variables, deep breathing and Valsalva ratio which are the markers of parasympathetic reactivity were comparable. Similarly, rise in diastolic blood pressure during handgrip and change in systolic blood pressure in head up tilt which are the markers of sympathetic reactivity were also comparable. Conclusion: This study concludes that the parental history of diabetes does not have an impact on cardiovascular autonomic function in offsprings between the age group of 18 and 30 years.
Stroke
Introduction: While the goal of IV tissue plasminogen activator (TPA) is to prevent infarction, f... more Introduction: While the goal of IV tissue plasminogen activator (TPA) is to prevent infarction, few data exist on averted stroke. Methods: Secondary analysis of a multicenter trial from 2014-2020 comparing outcomes between patients treated for stroke by mobile stroke unit (MSU) vs standard care (SC). The analytical cohort were patients with suspected stroke treated with IV TPA. The primary outcome was a time-defined averted stroke diagnosis, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours. The secondary outcome was a tissue-defined averted stroke diagnosis, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours and no acute infarction/hemorrhage on imaging. We used multivariable logistic regression to evaluate associations between study exposures (demographics, comorbidities, stroke characteristics) and outcomes. Results: Among 1009 patients with a median last known well-to-TPA time of 87 minute...
CONTINUUM: Lifelong Learning in Neurology, 2020
Rapid eye movement (REM) sleep behavior disorder (RBD) may result in a patient injuring a bed par... more Rapid eye movement (REM) sleep behavior disorder (RBD) may result in a patient injuring a bed partner while acting out a dream. This article examines the complexities associated with RBD as a criminal defense strategy as well as the legal implications for physicians and their duty to patients and their families to mitigate risks associated with possible injuries related to RBD.
Tienda online donde Comprar Neurology Secrets (Online And Print) 6th Ed. al precio 3687,60 € de J... more Tienda online donde Comprar Neurology Secrets (Online And Print) 6th Ed. al precio 3687,60 € de Joseph S. Kass | Eli M. Mizrahi, tienda de Libros de Medicina, Libros de Neurologia - Neurologia general
Neurology, 2014
OBJECTIVE: To determine the feasibility of mentored peer review as an educational tool for teachi... more OBJECTIVE: To determine the feasibility of mentored peer review as an educational tool for teaching neurology residents fundamental principles of biostatistics, research methodology, and peer review. BACKGROUND: Learning to appraise scientific literature critically and apply this skill to clinical practice is an ACGME core competency or milestone, Practice-Based Learning and Improvement. Innovative approaches to such instruction are lacking in neurology training. DESIGN/METHODS: A partially-blinded, randomized, controlled multi-center pilot study of mentored peer review recruited PGY-3 and PGY-4 neurology residents from nine training programs. Five standardized manuscripts with introduced errors were distributed at two month intervals and reviews written by trainees were graded by blinded assessment using a validated instrument, the Review Quality Instrument (RQI). Residents were randomized to receive either unstructured faculty mentoring on peer review or no mentoring. Primary outc...
Journal of Alzheimer's Disease, 2021
Longitudinal observational cohort studies are being conducted worldwide to understand cognition, ... more Longitudinal observational cohort studies are being conducted worldwide to understand cognition, biomarkers, and the health of the aging population better. Cross-cohort comparisons and networks of registries in Alzheimer’s disease (AD) foster scientific exchange, generate insights, and contribute to the evolving clinical science in AD. A scientific working group was convened with invited investigators from established cohort studies in AD, in order to form a research collaboration network as a resource to address important research questions. The Connecting Cohorts to Diminish Alzheimer’s Disease (CONCORD-AD) collaboration network was created to bring together global resources and expertise, to generate insights and improve understanding of the natural history of AD, to inform design of clinical trials in all disease stages, and to plan for optimal patient access to disease-modifying therapies once they become available. The network brings together expertise and data insights from 7...
Alzheimer's & Dementia, 2018
Compared to scoring 1, scoring 5 on the ADFlag scale conveyed a 19.66-fold increase (15.98-24.18;... more Compared to scoring 1, scoring 5 on the ADFlag scale conveyed a 19.66-fold increase (15.98-24.18; Chisq<0.0001) in the odds for incipient AD diagnostic by A+T+N+ criteria, and scoring 4 a 2.96-fold increase (2.62-3.33; Chisq<0.0001). Patients scoring 5 on the ADFlag scale were all part of the Alzheimer’s pathophysiologic continuum (A+). Together, patients scoring either 4 or 5 represented 73% of all A+ patients, including 63.63% of the A+T+N+ or A+T+N(incipient AD). Moreover, we found that an ADFlag score of 4 at baseline significantly increased the odds for conversion 4.17-fold compared to patients scoring 1 (3.61-4.80; Chisq<0.0001) and 8.34-fold compared to patients scoring 3 (6.37-10.91; Chisq<0.0001). A generalized regression predictive model confirmed the association between conversion to AD and scoring 4 on the ADFlag scale. Conclusions: ADFlag has significant prognostic value and it’s use as a stratification tool to prescreen aMCI patients into preventive or therapeutic trials may enhance their chance of success.
Alzheimer's & Dementia, 2017
Continuum (Minneapolis, Minn.), 2016
This article presents a case in which a neurology group practice is considering investing in an i... more This article presents a case in which a neurology group practice is considering investing in an imaging center that is owned by nonphysician investors with the aim of referring patients to this imaging center. The article reviews some important legal pitfalls in federal law that physicians must be aware of when considering such an investment and focuses on the general outlines of and exceptions to the Stark Law and the Federal Anti-Kickback Statute.
Oxford Medicine Online, 2017
HIV causes a chronic form of encephalitis (HIVE) that is clinically characterized by either demen... more HIV causes a chronic form of encephalitis (HIVE) that is clinically characterized by either dementia or mild neurocognitive impairment. Since the introduction of antiretroviral therapy in 1996, the incidence of HIV dementia has decreased by 50%, but the prevalence of mild neurocognitive disorder has increased up to 39%. HIVE is the result of direct microglial infection, interruption of trophic factors, or caused by inflammatory cytokines. HIV enters the brain primarily by the “Trojan horse mechanism”; it is carried by monocytes and lymphocytes that cross the blood–brain barrier. HIV has a predilection for the basal ganglia, deep white matter, and hippocampus, resulting in a subcortical dementia. HIV dementia is a diagnosis of exclusion and other co-infections, cerebrovascular disease, malnutrition, and drug abuse should be ruled out before making the diagnosis. In patients receiving antiretroviral therapy with immunological response, a novel condition termed CD8+ T cell encephalitis...
CONTINUUM: Lifelong Learning in Neurology, 2015
Regardless of their specialty, physicians encounter various potential clinical emergencies in the... more Regardless of their specialty, physicians encounter various potential clinical emergencies in their outpatients that may require referring patients for the appropriate level and urgency of care. One such situation is the outpatient who presents with suicidal or homicidal ideation. In this circumstance, the physician is faced with performing a rapid evaluation of the symptoms, determining the acuity of the situation, and safely referring the patient to an appropriate level of care. Using case vignettes, this article reviews some of the immediate critical factors to consider in evaluating and managing the outpatient who expresses thoughts of suicide or homicide.