Norman L Keltner

• University of Alabama at Birmingham

This article explores the recently recognized anti-NMDA receptor encephalitis, which may produce psychiatric symptoms. Historically, some patients presenting for psychiatric care may have actually been suffering from anti-NMDA encephalitis; thus, awareness of this disorder may facilitate appropriate treatment. Early diagnosis and aggressive treatme...

Complex healthcare, less resources, high-level medical equipment, and fewer available clinical settings have led many health professionals to use simulation as a method to further augment educational experiences for nursing students. While debriefing is recommended in the literature as a key component of simulation, the optimal format in which to c...

The presence of a psychiatric illness increases the risk of exposure to HIV and disease complications; however, effective treatments have substantially reduced mortality in adults with HIV. Despite such effective treatments, nearly half of adults with HIV experience neurocognitive deficits that can affect job-related and everyday tasks, thus reduci...

Neuroanatomy correlates with the psychological changes of pain. Neuroplastic transformation appears in the reduction of gray matter volume, or shrinkage in the top-down cortical areas vital for working memory, problem solving, sequencing and discrimination of different information and cognitive modulation of pain via the descending pain modulatory...

To successfully negotiate and interact with one's environment, optimal cognitive functioning is needed. Unfortunately, many neurological and psychiatric diseases impede certain cognitive abilities such as executive functioning or speed of processing; this can produce a poor fit between the patient and the cognitive demands of his or her environment...

Health professionals can gain a better understanding of key elements of social support by examining reasons why people living with human immunodeficiency virus/acquired immunodeficiency syndrome (PLWH) exclude individuals from their chosen families (ie, families of choice). Our study identified reasons why PLWH excluded specific individuals from th...

In addition to the immune system, HIV affects the nervous system and the brain, producing neurological sequelae, often resulting in forgetfulness and cognitive problems. These problems can compromise medication adherence, interfere with instrumental activities of daily living such as driving and managing finances, increase dependency, and decrease...

Social support, stigma, and social problem solving may be mediators of the relationship between sign and symptom severity and depressive symptoms in people living with HIV (PLWH). However, no published studies have examined these individual variables as mediators in PLWH. This cross-sectional, correlational study of 150 PLWH examined whether social...

HIV influences those with the disease as well as their families and social relationships. The chosen families of persons living with HIV (PLWH) provide structure, social support, and security. Our study identified reasons why PLWH included specific individuals in their chosen families (or families of choice). This mixed-method design used a conveni...

Schizophrenia is a heartbreaking, debilitating, youth-stealing, lifetime disorder for most individuals afflicted with it. While the serendipitous discovery of chlorpromazine 60 plus years ago and the subsequent “discoveries” since have significantly reduced positive symptoms, the devastation of negative/cognitive symptoms continues to ruin lives. G...

Nurses with a medical-surgical clinical focus often care for patients with psychiatric and behavioral issues in acute care hospitals. This article describes how hospital staff and nursing and theater department faculty joined forces to develop realistic simulated psychiatric scenarios for use by practicing nurses.

Pharmaceutical advances in suppressing viral replication of HIV has resulted in improved prognosis of those infected with HIV. As a result, adults infected with HIV are approaching nearly normal life expectancies. In fact by 2015, nearly half of those with HIV will be 50 years of age and older. Although the increase in life expectancy among HIV-pos...

Using actors in simulation provides opportunities for immersive, interactive, and reflective experiences to improve health care professionals' clinical expertise and practice. These experiences facilitate the development of enhanced critical thinking, problem-solving, and communication skills without risks to patients. This article discusses how to...

In greater numbers than in prior conflicts, service members deployed as part of Operation Enduring Freedom and Operation Iraqi Freedom have an increased risk of experiencing a traumatic brain injury (TBI). The basics of TBI are discussed, with particular attention paid to blast-related events, as this is a common mechanism of injury in this populat...

With the growing population of older adults, nurses will need to address age-related cognitive declines. Evidence demonstrates that cognitive remediation training is effective in improving neuropsychological abilities in older adults, which can translate into improved functioning in instrumental activities of daily living. The future of cognitive r...

Procedural and Emotional Religious Activity Therapy encapsulates an approach to engaging older adults with Alzheimer's disease in meaningful activities that can be performed within the parameters of their cognitive functioning. Alzheimer's disease disrupts some brain structures more than others, resulting in a disproportionate loss of certain cogni...

Aim. To identify sources of functional social support (i.e. appraisal, belonging and tangible) provided to people living with human immunodeficiency virus/acquired immune deficiency syndrome through biological, legal or social relationships. We also examined associations between self-described sexual orientation (heterosexual vs. homosexual), gende...

This column on atypical antipsychotics is the first of two parts. Part I consists of a review of foundational information and a discussion on clozapine and risperidone. Part II will address olanzapine, quetiapine, and ziprasidone.

With this issue, PPC introduces a new column, Brain Update. This ongoing column will provide the practicing nurse with featured aspects of brain biology. PPC offers this new feature in an effort to enable nurses to integrate brain biology more effectively into their practice. Topics of future columns will include the basal ganglia, the limbic syste...

From newspaper accounts to research in highly reputable journals, there is cause to believe that the neuropsychiatric phenomenon of paranoia is increasing. From a strictly biologic perspective, increased levels of dopamine, whether endogenous as in schizophrenia or drug-induced as with methamphetamine, cause paranoid thinking. Dopamine elevation mo...

After a 4-year hiatus, this column returns as a regular fixture of Perspectives. As before, the emphasis will be on biological aspects of understanding and/or treating mental disorders. It is an interesting time to reintroduce this column, because now we can look back on the “decade of the brain” in its entirety and begin assessing its impact on ps...

The purpose of this study was to identify relationships of individuals that people living with human immunodeficiency virus/acquired immune deficiency syndrome (PLWH) in a city in the USA include in their family of choice, or chosen family. The convenience sample in this cross-sectional, exploratory study consisted of 150, mostly male and African A...

Brain Update provides practicing nurses with featured aspects of brain biology. PPC offers this feature in an effort to enable nurses to integrate brain biology into their practice. The purpose of this column is to focus on the biological causes of mental illness. Topics of future columns will include the limbic system, the extrapyramidal system, a...

Lithium remains an important agent in the treatment of BPD; however, from cases presented here and others found in the literature, it should be given with care. Not only are patients at risk during lithium therapy, but also evidence mounts that irreversible neuropathies can occur.

Two relatively new, yet interrelated, phenomena have been broached in this report: the increase in psychiatric patients within the penal system and the ever novel ways in which the medication used for their treatment can be misused. The extent to which these problems cost the jail/prison system, jeopardize mental health services, and interfere with...

This cross-sectional exploratory study examined relationships among functional social support, HIV-related stigma, social problem solving, and depressive symptoms in a convenience sample of 30 men and nonpregnant women who sought care at two HIV outpatient clinics in the southeastern United States. Participants completed a set of self-report questi...

PurposeThis article explores the recently recognized anti-NMDA receptor encephalitis, which may produce psychiatric symptoms.Conclusions Historically, some patients presenting for psychiatric care may have actually been suffering from anti-NMDA encephalitis; thus, awareness of this disorder may facilitate appropriate treatment.Treatment Implication...

In the past, most of us have understood the concept of the first messenger system. This article has also addressed the importance of the second messenger system and its implications in the treatment of anxiety, bipolar disorder, and depression. Understanding the second messenger system will complement existing knowledge, which is necessary to remai...

Individuals with schizophrenia have a high risk for medical comorbidities. This paper has discussed weight gain, diabetes, and dyslipidemia as major effects of the use of atypical antipsychotic agents. These effects, in turn, are known to lead to CVD and the end results of diabetes. Adiseshiah (2005) suggests that nurses are in a pivotal position t...

(a) to summarize genomic influences in schizophrenia, (b) to review the molecular genetic profile associated with schizophrenia, (c) to summarize the genetic factors affecting dopamine and serotonin neurotransmitter systems, and (d) to list nursing implications for this knowledge. Schizophrenia and schizophrenia-spectrum disorders, both clustered i...

Nothing is more addictive than the high of a manic euphoria. —Margo Orum, 1996

The forgoing represents an attempt to reduce psychopharmacology to a presynaptic neuron-synapse-post-synaptic neuron event. Obviously other strategies might be employed resulting in equal or perhaps greater clarity. Limitations of this approach include the lack of discussion about neuronal modulation, second messenger systems (which most NTs discus...

Annie dreaded what would happen next-she had been down this road many times before. There she was-minding her own business, just wanting to watch a movie like any normal person-when she noticed her breathing was off. Immediately she began to monitor her breathing and soon it seemed as she just could not get enough air. She remembered a recent visit...

This is the second of two columns on atypical antipsychotic drugs. Part II discusses olanzapine, quetiapine, and ziprasidone.

SSRI-induced sexual dysfunction affects 30% to 50% or more of individuals who take these drugs for depression. Biochemical mechanisms suggested as causative include increased serotonin, particularly affecting 5HT2 and 5HT3 receptors; decreased dopamine; blockade of cholinergic and alpha-1 adrenergic receptors; inhibition of nitric oxide synthetase;...