Length of stay and recidivism on a psychiatric intensive care unit.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
L Citrome
Publications and source records attributed to L Citrome.
Management of depression. Current options for this highly treatable disorder.
Depression is a common disorder that leads to substantial functional impairment and even death if untreated. Suicide rates in persons with untreated major depression can be as high as 30%. However, the disorder is treatable; pharmacotherapy in combination with psychotherapy is effective in up to 90% of patients. Established diagnostic criteria enable physicians to differentiate major depression from other psychiatric disorders and from somatic conditions that may mimic depression. Current treatment options include traditional antidepressant medications as well as the newer serotonin-reuptake inhibitors. Successful treatment depends on administration of an appropriate dose for an adequate duration.
Antidepressive Agents↗
The dangerous agitated patient. What to do right now.
Short-term management of the agitated patient involves the use of psychological, behavioral, diagnostic, and pharmacologic options. Knowledge of verbal interventions may help physicians prevent personal injury and destruction of property. Accurate diagnosis allows safe and effective pharmacologic intervention. Involuntary treatment in emergency situations is legal; however, clearly documenting all clinical events is essential.
Adult↗
A double-blind, placebo-controlled study of adjunctive nadolol in the management of violent psychiatric patients.
We report a controlled 3-week study (n = 30) of adjunctive use of nadolol, 80 to 120 mg per day, vs. placebo for the management of violent psychiatric patients. There were no remarkable adverse cardiac effects at this dose. The active treatment group showed lower total Brief Psychiatric Rating Scale (BPRS) scores after the first week of treatment (analysis of covariance [ANCOVA], p less than .08) and similar trends for the activation factor and the hostility scale. There were parallel findings for measures of extrapyramidal symptoms (EPS) (Simpson-Angus Neurological Rating Scale), which were reliable after the second week (ANCOVA, p less than .02). A significant association between changes in EPS and BPRS scores was found by regression analysis, after the effects of baseline measures were removed. Given that nadolol does not penetrate the central nervous system well, the antiaggressive effects may be associated with sympathetic nervous system feedback mechanisms.
Adult↗
Differential diagnosis of psychosis. A brief guide for the primary care physician.
By keeping in mind that not a psychosis is schizophrenia, the primary care physician can often avoid misdiagnosis in behaviorally disturbed patients. Abnormal behavior may result from mood disorders, drug-induced psychosis and other organic disorders, personality disorders, delusional disorders, autism, or mental retardation. A long-term history is essential for correct diagnosis and treatment.
Affective Disorders, Psychotic↗
Use of lithium, carbamazepine, and valproic acid in a state-operated psychiatric hospital.
OBJECTIVE: To examine the prescribing of mood stabilizers (lithium, carbamazepine, and valproic acid) in a 500-bed state-operated psychiatric hospital in New York. METHODS: All 129 inpatients receiving mood stabilizers were identified and their medical records reviewed using a standardized drug use evaluation form. Diagnosis, other indications, and prior experience with mood stabilizers were examined, as well as outcome and adverse effects. RESULTS: Approximately one-quarter of the inpatient population received a mood stabilizer. The frequency of carbamazepine use exceeded the use of lithium, with 72 patients receiving carbamazepine and only 62 receiving lithium. Twenty-eight patients received valproic acid. Indications found most frequently for carbamazepine use included assaultive or aggressive behavior (70% for those receiving carbamazepine as the only mood stabilizer). Of those patients with bipolar or schizoaffective disorder and receiving either lithium, carbamazepine, or valproic acid, 36% were prescribed carbamazepine (10% as a first-line agent) and 50% lithium (26% as a first-line agent). None of these indications for carbamazepine has been approved by the Food and Drug Administration. In general, positive outcomes were documented but without supporting objective measures. Significant adverse effects were documented in the medical record in one-quarter of the patients. CONCLUSIONS: There was widespread use of the three mood stabilizers examined, singly and in combination, for a variety of indications. Lithium and valproic acid remain more frequently prescribed for the treatment of bipolar and schizoaffective disorders. Monotherapy with carbamazepine or valproic acid results in statistically significantly fewer adverse effects than lithium or combination therapy (p values between p = 0.00038 and p = 0.006). Current clinical practice has endorsed the use of carbamazepine for aggressive or assaultive behavior, although there does not appear to be sufficient proof of effectiveness in the literature. Formal studies of carbamazepine's antiagressive effects should be conducted.
Aggression↗
Update on the biological treatment of aggression.
This review is focused on aggressive behavior in adult patients with major mental disorders. Aggression, agitation, and hostility are defined. The roles of intramuscular forms of ziprasidone and olanzapine in the treatment of acute agitation and aggression are discussed. We review general considerations pertaining to persistent aggression in inpatients and outpatients, including comorbidity of major mental disorders with substance use disorders and personality disorders. The role of clozapine as an antiaggressive agent is well established, particularly in inpatients. Evidence also exists for the efficacy of risperidone, olanzapine, quetiapine, and aripiprazole. Anticonvulsants and lithium are widely used with the intent to control aggression, but their efficacy lacks strong evidential support. Benzodiazepines have a role in controlling acute agitation, but their long-term use for persistent aggression is not recommended. There is evidence for antiaggressive effects of SSRIs and hormonal agents with antiandrogenic properties. Beta-adrenergic blockers and electroconvulstive treatment are rarely used in clinical practice to control aggression, but they may be effective. The heterogeneity of aggressive behavior is a challenge for developing rational treatments. Emerging genetic findings hold a promise of future treatments of aggressive behavior developed on the basis of individual patients' genotypes.
Adrenergic beta-Antagonists↗