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

Partial hospitalization programs represent a midpoint along the treatment intensity continuum between an inpatient and an outpatient service. Partial hospitalization programs can be used in place of an inpatient unit for patients who need crisis stabilization and amelioration of their acute symptoms, but who are not imminently homicidal or suicidal. Partial hospitalization programs can also manage adjustments in pharmacotherapy, conduct skills classes, and engage patients in group psychotherapy. In this article, the authors describe the roles and functions of partial hospitalization programs in today's spectrum of psychiatric services and describe the process of transition from an acute inpatient unit to a partial hospitalization programs.

Objective. While there has been a great deal of speculation by clinical researchers over the last three decades on effective and safe methods for the pharmacological management of aggression in children and adolescents, it is only in the last decade that there have been well-designed studies available to address this issue. Medication is commonly used to control aggression in children and adolescents in inpatient units. Also, there exists a need for evidence-based guidelines for the use of these different pharmacological agents for managing pediatric aggression on inpatient units. The aims of this article are to provide a systemic review and to provide treatment guidelines based on these limited but currently available studies.Methods. The articles reviewed in this study were obtained through a PubMed search using the key words 'children,' 'adolescents,' 'aggression,' 'inpatient,' 'ziprasidone,' 'lithium,' and 'risperidone.' A total of 499 studies were generated. Only studies focusing on pharmacological management of inpatient pediatric aggression with mean duration less than six weeks and published during January 1980 to August 2009 were included. Only English articles were considered. A total of 13 studies met these criteria, which were included in the review without any further statistical analysis. Recommendations are made on this available evidenced-based literature.Results. There is some evidence for the standing use of oral lithium, haloperidol, olanzapine, and risperidone for aggression related to specific psychiatric diagnoses. Intramuscular ziprasidone and olanzapine administered as needed were found to be effective for the rapid management of moderate to severe aggression. Oral or intramuscular diphenhydramine administered as needed was found to be useful for managing mild aggression due to a placebo effect.Conclusions. Studies are available on managing aggression in children and adolescents in inpatient treatment settings but are limited. Further studies on the use of various psychotropic medications are needed in order to develop comprehensive guidelines for the safe and effective pharmacological management of child and adolescent inpatient aggression.

Through media depictions, the public is becoming increasingly aware of the phenomenon of hoarding. Hoarding refers to the excessive acquisition of relatively worthless items, which eventually results in the compromise of living space and/or the daily activities of affected individuals. As a symptom, hoarding is relatively common in a significant minority of individuals with obsessive-compulsive disorder. In the context of obsessive-compulsive disorder, symptoms typically emerge in the teens through the early 20s. However, hoarding also appears to exist as a distinct syndrome, which is characterized by late onset, childhood adversity, various Axis II traits, and a history of alcohol misuse. While the explicit position of hoarding in the psychiatric nomenclature remains undetermined, this behavior is likely to surface in both psychiatric and primary care settings.

Impairments in different cognitive abilities have been found to be correlated with reduced real-world functioning in people with schizophrenia. A number of other features of the illness, such as depression and negative symptoms, contribute to the overall prediction of these outcomes. Impairment in social cognition is of particular interest as a mediating influence between cognition and social outcomes. Social cognition is a set of cognitive processes applied to the recognition, understanding, accurate processing, and effective use of social cues in real-world situations. In schizophrenia research, social cognition comprises the following domains: emotion perception, theory of mind (ToM), and attributional style. While substantial research has indicated that these abilities are clearly related to social outcomes, research has been slowed by problems in the measurement of these abilities. In this article, I will describe these abilities, discuss how they are currently measured, and how research could improve the current measurement of these abilities to make them more clinically useful.

We analyzed use of therapeutic drug classes for the treatment of depression by the three levels of physician-reported disease severity (mild, moderate, and severe) to understand if the mix of therapeutic classes used to treat depression changes as disease severity increases. Prior to analyzing drug uses in each severity category, we established that in the 12 months ending November 2009, the majority of patients (65%) were assigned a severity rating of 'moderate' by their physician; 27 percent and eight percent of patients were designated as 'mild' and 'severe,' respectively. In general, we found that as disease severity changes, so too do the proportions of the various therapeutic classes used in depression. The differences in class mix by severity have persisted at least since the 12 months ending December 2008, and it appears that the mix of drug classes used in severe depression are becoming less similar to the class mix for moderate depression over time.

Objective. This open-label study examined the safety and efficacy of ziprasidone intramuscular with geriatric patients experiencing psychosis or agitation.Design. During an inpatient stay, consenting subjects who became acutely psychotic or agitated received ziprasidone intramuscular 10mg q 6 to 8 hours, up to a maximum dose of 20mg/24 hours. A within-group repeated measures design was employed to study whether the use of ziprasidone over the 24-hour observation period contributed to decreased agitation or to extrapyramidal side effects. The data were analyzed using an Analysis of Variance with trend analysis.Setting. The study was conducted on the geriatric psychiatry inpatient unit at the University of Toledo Medical Center, Toledo, Ohio.Participants. Fourteen patients, six men and eight women with mean age 77+/-8 years, participated in this study. Each patient had a diagnosis of dementia, co-occurring with one of the following: delirium, major depressive disorder with psychotic features, schizophrenia, bipolar disorder, or schizoaffective disorder.Measurements. The Brief Psychiatric Rating Scale, Delirium Rating Scale, and the Behavioral Activity Rating Scale were obtained at baseline and at 0.5, 2, and 24 hours after the first dose of ziprasidone intramuscular.Results. Overall, physiologic measures that would indicate undesirable side effects, including QTc intervals, remained unchanged pre- and post-study. However, there were significant improvements in scores on a variety of measures assessing agitation or psychosis.Conclusion. This study suggests that ziprasidone intramuscular may be a safe and effective short-term treatment for agitated or psychotic geriatric patients, and, therefore, additional studies should be conducted to confirm these findings.

Quetiapine, an atypical antipsychotic, has been the subject of a series of case reports that suggest a potential for misuse/abuse. The available cases indicate a male predominance; oral, intranasal, or intravenous routes of administration; misuse/abuse in jail or inpatient psychiatric settings; and subjects with extensive histories of polysubstance abuse. While possible pharmacological explanations have been proffered, compared to the other atypical antipsychotics, there is no clear explanation for an alleged higher risk of misuse/abuse with quetiapine. Likewise, there are no available animal or human empirical studies to evaluate risk. At this juncture, clinicians in psychiatric and primary care settings can only remain alert to a potential risk, particularly in patients who meet the current demographic profile.