Psychiatry (Edgmont (Pa. : Township))最新文献

In the existing literature, selective serotonin reuptake inhibitor exposure has been occasionally associated with both behavioral apathy and emotional blunting. While frequently described as separate entities, these two syndromes are mutually characterized by indifference and may be united under the single moniker, "selective serotonin reuptake inhibitor-induced indifference." Little is known about the epidemiology or etiology of selective serotonin reuptake inhibitor-induced indifference and few empirical studies have been undertaken. However, this syndrome may be under-recognized by both clinicians and patients (i.e., low insight, particularly among children and adolescents), and is characterized by an insidious onset, dose-dependent effects (i.e., higher selective serotonin reuptake inhibitor doses are more likely to result in symptoms), and complete resolution of symptoms with the discontinuation of the offending drug. Treatment strategies may include a dose reduction of the offending selective serotonin reuptake inhibitor, augmentation with a second drug, and/or discontinuation of the selective serotonin reuptake inhibitor and subsequent treatment with a nonselective serotonin reuptake inhibitor antidepressant.

Alzheimer's disease is a devastating illness, and patients may be exceptionally concerned that they have genes that contribute to this illness, especially if there is a family history of Alzheimer's disease. This article reviews core findings regarding the genes that contribute to the early-onset (familial) and late-onset forms of Alzheimer's disease and related findings regarding the needs of psychiatrists when discussing the disease with patients. Previously, clinicians believed that patients who tested positive for the APOE gene linked to late-onset Alzheimer's disease would be harmed by this knowledge to a greater extent than those who did not know they had the gene. Thus, clinicians were strongly recommending to patients that they not have this testing. This article includes the practice-changing relevance of a recent study published in the New England Journal of Medicine, which reported that a group of patients tested for the APOE gene who found out that they were positive for this gene were not significantly harmed by having acquired this knowledge.

In this Trend Watch, we look at retail pharmacy prescriptions for branded and generic attention deficit hyperactivity disorder treatments, atypical antipsychotics, selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors and analyze the average out-of-pocket costs incurred by patients who are covered by commercial third-party prescription plans (i.e., as opposed to patients covered by Medicaid or patients with no prescription coverage). Overall, patient out-of-pocket costs in commercial third-party plans are lower for generic prescriptions than they are for brand prescriptions by at least $19.02. Comparisons across the drug classes reveal that the average co-pay for brands and generics, as well as the difference between brand and generic out-of-pocket costs, differ by drug category.

Sudden cardiac death has become a significant clinical concern when prescribing antipsychotic drugs, especially to older people with dementia. Sudden death syndrome has been known for decades to occur in association with taking first-generation antipsychotic medications, but it has become more prominent recently due to safety reviews about the use of second-generation antipsychotic medications. In 2005, the United States Food and Drug Administration disseminated information about cardiac fatalities, which led to black box warnings in second-generation, antipsychotic, drug-prescribing literature about higher mortality when administering to elderly persons with dementia-related psychoses. In this population, treatment results in death rates of 4.5 percent, as compared to 2.6 percent in subjects taking a placebo. Actually, patients treated with both the first- and second-generation versions experienced an increased incidence of fatalities. Before utilizing these agents, a careful workup must be completed. The presence of a psychosis or mania should be the only conventional indication for prescribing first- and second-generation antipsychotic medications. Physicians should always evaluate patients for comorbid conditions, especially heart disease and metabolic abnormalities, and all currently used medications to assure a risk-to-benefit ratio favoring the application of an antipsychotic medication. An electrocardiogram is a part of the evaluation of the cardiac status and determines the base line QT interval. While prescribing these medications in elderly patients, physicians must provide individualized clinical, electrocardiographic, and pharmaceutical monitoring.

According to clinical experience, the Diagnostic and Statistical Manual of Mental Disorders, and authorities in the field, patients with borderline personality disorder tend to be hyper-reactive to environmental stimuli. In addition to the preceding clinical impressions and experiences, the majority of empirical studies in this area have concluded that patients with borderline personality disorder are indeed hyper-responsive to experimental environmental stimuli, whether the stimuli are negative, positive, or even neutral or ambiguous. While two empirical studies did not find hyper-responsiveness, both were undertaken in inpatients with borderline personality disorder, and the potential for emotional blunting from psychotropic medications may have been a potential confound. These findings have several clinical implications in both mental health and primary care settings.

The cerebellum has long been considered quite separate from the neocortex, and accordingly the understanding of its role has been limited. Recent work has revealed that the cerebellum interacts regularly with the forebrain and it is involved in mood and cognition. In this article, the authors discuss an extensive system of neural circuits connecting the prefrontal, temporal, posterior parietal, and limbic cortices with the cerebellum. Language functions of the cerebellum are described, as well as cerebellar syndromes affecting cognition. The roles of the cerebellum in pain perception, attention deficit disorder, autism, dementia, and schizophrenia are discussed. Practical observations and tests to assess cerebellar function in the psychiatrist's office are described.

Objective. There exists uncertainty regarding the role of magnetic resonance imaging in the evaluation of intensive care unit delirious patients. This case series describes preliminary magnetic resonance imaging findings obtained because of delirium, subsequent in-hospital clinical decisions, and post-discharge neurocognitive outcomes in intensive care unit survivors.Design. Case series.Setting. Intensive care unit.Participants. Eight patients who underwent magnetic resonance imaging for delirium in the absence of focal neurological findings as part of their intensive care unit clinical care.Measurements. Magnetic resonance imaging findings, clinical decisions following magnetic resonance imaging, and three-month neuropsychological outcomes were obtained.Results. Of the eight patients, six (75%) demonstrated white matter hyperintensities, one (12%) had mild atrophy, and no patient had ischemic/hemorrhagic lesions. Magnetic resonance imaging did not lead to new diagnoses or immediate changes in therapy. All six patients who underwent neuropsychological testing had severe impairments in memory, executive function, and attention at three months, despite the absence of baseline cognitive impairment.Conclusion. Magnetic resonance imaging findings in these delirious intensive care unit patients did not alter the immediate treatment course and these patients had neuropsychological impairments at three months. Future research is warranted to define the role of current and newer magnetic resonance imaging techniques in assessing and managing delirious intensive care unit patients, and to examine relationships between in-hospital magnetic resonance imaging findings (i.e. white matter hyperintensities) and short- and long-term neurological outcomes.

Objective. Foreign body ingestion can be a challenge to multiprofessional approaches involving medical, surgical, neurological, and psychiatric teams.Case presentation. A 41-year-old male patient with intellectual disabilities presented after having swallowed approximately 20 sharp objects. While admitted to a psychiatric ward, surgeons removed a glove from his stomach endoscopically and pharmacologically facilitated the objects' complication-free bowel passage. The patient explained the swallowing as a means to release himself from tension induced by stress. His aberrant behavior also seemed to serve as a means to exert pressure on psychosocial workers. Other deviations included the pushing of sharp objects under the skin and multiple paraphiliae. As a child, the patient suffered from early psychological and physical traumatization. Both parents were allegedly physically abusive alcoholics.Conclusion. Apart from possible alcohol embryopathy and traumatic brain damage, meningitis, which the patient had at the age of three, is discussed as the most likely reason for his oligophrenia, associated with left-sided, temporo-parietal atrophy and epilepsy.

In this article, we explore the current state of the psychiatry drug development pipeline. Analysis suggests that overall, the psychiatry pipeline is heavily skewed toward a few major indications and tends to have more programs in early development (Phase I and II) than later stages (Phase III). A review of development sponsors shows a fairly even split of programs between Top 50 Pharmaceutical companies and small to mid-sized biopharmaceutical companies.