A study of postevaluation change in clinician and treatment dropout rates.
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Biomedical subjects
Publications and source records attributed to M I Good.
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The antimalarial chloroquine is a widely used medication prescribed for a variety of conditions. The authors indicate that its lethality and behavioral side effects are significant and may be underestimated. Moderately low overdosage of chloroquine can result in rapid death. Moreover, therapeutic doses are known to cause psychosis, delirium, personality changes, and depression. It is hypothesized that a drug-induced alteration of mood or a toxic confusional state may result in unintended overdosage and death. Clinicians should consider prodromal signs of toxicity and not classify overdosage prematurely as attempted self-poisoning.
In a study of 53 medical-surgical patients who were in extended care and were consecutively referred for psychiatric evaluation, 7 (13%) of the patients had been considered to have unequivocal dementia, yet 3 of them (6% of the total or 43% of those considered demented) were found to have a false-dementing psychiatric disorder. Physical findings contributed to masking the psychopathology, which included psychotic depression with the Ganser symptom in 2 patients and hysterical pseudodementia with depression in 1 patient. Criteria that have been recommended to differentiate pseudodementia from dementia could lead to misdiagnosis in the type of case described, which suggests the need for a typology of depressive pseudodementia.
The author describes the case of a patient who received neuroleptics and antiparkinsonian medications for more than 7 years and whose tardive dyskinesia symptoms disappeared after trihexyphenidyl was discontinued. The case appears to support the hypothesis that there is a threshold effect of antiparkinsonian agents on tardive dyskinesia.
Aggressive and criminal behavior among patients with manic and depressive conditions has been in need of greater delineation, particularly since the advent of current pharmacotherapies. This report reviews the literature on aggression and criminality among bipolar and unipolar patients and the nature and occurrence of these conditions among criminal and unprosecuted offender populations, and presents a study of 100 consecutive prisoners (89 women, 11 men) referred for psychiatric evaluation. It is hypothesized that manic and depressive states are underdiagnosed in prison populations, particularly among female prisoners. A comparatively high incidence (10%) of primary affective disorder was found in this study; possible causes of the hypothesized underdiagnosis are discussed.
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Although the antimalarial agents chloroquine, hydroxychloroquine, and amodiaquine are widely used to treat a variety of medical conditions, their behavioral toxicity and lethality are not generally recognized. Therapeutic doses sometimes cause psychosis, delirium, personality change, and depression. Since moderately low overdoses of chloroquine can result in rapid death, such behavioral effects could lead to accidental or state-dependent overdosage and death.
The authors describes a patient who presented catatonialike symptoms and dyskinesias associated with glutethimide discontinuance and antihistamine use. He hypothesizes that altered dopamine metabolism may produce some of the unusual neuropsychiatric characteristics of glutethimide withdrawal. Drug-withdrawal catatonia may be an additional entity in the differential diagnosis of catatonialike states of organic etiology.
The drug-automatism hypothesis implies a medication-induced absence of intentionality for self-poisoning and a relative amnesia for serial or single overdosage. Controversy stems from problems encountered in the formulation and verfication of the hypothesis. The author reviews the literature, presents a case associated with a proprietary sleeping preparation, and discusses psychopharmacological and psychophysiological elements in the mechanism of drug automatism and its differential diagnosis.
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The question of whether organic conditions, such as complex partial seizures, can cause dissociative symptoms is controversial. Although a diagnostic category for organic dissociation is included in the tenth edition of International Classification of Disease, it has never been identified in the Diagnostic and Statistical Manual. Its inclusion in the upcoming DSM-IV is currently under debate. This article surveys representative literature regarding the role of organic factors in the causation of dissociative symptoms and considers the differential diagnosis of organic dissociation from current and historic perspectives. Dissociative symptoms and disorders (including amnesia, fugue, depersonalization, multiple personality, automatisms, and certain furors) can be induced by a variety of medications, drugs of abuse, and medical illnesses or conditions affecting cerebral function. Organic dissociation can be distinguished from intoxication, amnestic disorder, and delirium. Psychiatric nosology and our conceptualization of altered mental states and functions would benefit from use of the concept of an organic dissociative syndrome, which has clinical, neurophysiologic, and medicolegal significance. Such a category should be included in DSM-IV.