1/27. 'Climbing the walls' ICU psychosis: myth or reality?The extent of the effect of the ICU environment on the psychological functioning on the ICU patient is explored. There is a need to understand all potential causes of disruption in psychological functioning in ICU patients. Co-ordination of all care carried out by multi-disciplinary team can help re-orientate patients and re-establish normal routines.- - - - - - - - - - ranking = 1keywords = psychosis (Clic here for more details about this article) |
2/27. Phenomenology and treatment of agitation.Agitation is a troublesome, common symptom in major depression that can be difficult to manage. It is sometimes a side effect of antidepressant treatment and may occasionally represent a mixed bipolar episode. If agitation fails to respond to an antidepressant alone, treatment may be augmented with a benzodiazepine, a neuroleptic, or lithium. Preliminary evidence indicates that divalproex, which has been found useful for bipolar disorder and for agitation associated with Alzheimer's disease, may also be effective for agitated depression. A controlled trial is now underway.- - - - - - - - - - ranking = 0.42489276875765keywords = depression, major (Clic here for more details about this article) |
3/27. Successful antidepressant treatment for five terminally ill cancer patients with major depression, suicidal ideation and a desire for death.In the debate on euthanasia and physician-assisted suicide, we have to exclude terminally ill patients in whom the desire for death is caused by major depression. However, it is still not clear to what degree major depression can be treated by psychiatric intervention in this setting. We evaluated the effect of antidepressant treatment in terminally ill cancer patients. Six cancer patients with suicidal ideas thought to be due to major depression were treated with tricyclic antidepressants. Three had requested terminal sedation to relieve them from their suffering. The median survival of five of these patients was 4 weeks after diagnosis; one was lost to follow-up. The efficacy of the antidepressant treatment was assessed using the Hamilton Rating Scale for depression (HRSD). One week after the start of treatment with antidepressants, five of the six patients showed a marked improvement in their mood and showed no further suicidal thoughts or requests for terminal sedation. The average reduction in the HRSD score was 23.4 points (14-38; SD = 9. 9). Antidepressant treatment can be effective in alleviating the desire for death due to major depression, even in terminally ill cancer patients.- - - - - - - - - - ranking = 1.7042490340472keywords = depression, major (Clic here for more details about this article) |
4/27. torsades de pointes secondary to intravenous haloperidol after coronary bypass grafting surgery.PURPOSE: Postoperative delirium occurs in about 2% of patients undergoing major cardiac surgery including coronary artery bypass grafting surgery (CABG). haloperidol (Sabex, Boucherville, canada) is a drug commonly used in the intensive care unit for the treatment of delirium and is usually considered safe even at high doses and is rarely implicated in the development of malignant ventricular arrhythmias such as torsades de pointes. The purpose of this study is to report such a complication of use of haloperidol after myocardial revascularization. CLINICAL FEATURES: The patient reported underwent uneventful triple bypass surgery. Administration of large intravenous doses of haloperidol was necessary for control of psychomotor agitation due to delirium. torsades de pointes occurred in the absence of QT prolongation on the third postoperative day following use of the drug with no other obvious etiological factor. CONCLUSION: awareness of this rare complication is key to judicious use of this drug in the post CABG patient in whom such an arrhythmia may have very deleterious consequences because of the underlying cardiac condition.- - - - - - - - - - ranking = 0.0011694897541552keywords = major (Clic here for more details about this article) |
5/27. "Herbal Ecstasy": a case series of adverse reactions.AIMS: To report five cases of adverse effects associated with the ingestion of "Herbal Ecstasy" tablets and discuss possible mechanisms of toxicity. METHOD: Composition of the "Herbal Ecstasy" tablets was determined by discussions with distributors and with MEDSAFE: Reference to relevant texts and an internet and medline literature search was used to identify articles of interest RESULTS: Three patients complained of minor symptoms such as perceptual disturbances, anorexia, inability to sleep, dizziness, palpitations and paresthesia. A fourth patient presented with palpitations and ventricular bigeminy, and a fifth patient presented with headache, vomiting, and a hypertensive crisis. Different brands of "Herbal Ecstasy" have different compositions, some containing caffeine and kava, and one contained ephedrine. CONCLUSION: These five patients presented with adverse reactions to "Herbal Ecstasy" ranging from minor to major. knowledge of the possible mechanisms of toxicity will help plan therapy in cases of major toxicity.- - - - - - - - - - ranking = 0.0023389795083105keywords = major (Clic here for more details about this article) |
6/27. The emergency treatment of depression complicated by psychosis or agitation.With the availability of newer, safer antidepressants in the past decade, initiation of definitive treatment for depression in the emergency setting has become an accepted practice. However, the use of newer antidepressants and atypical antipsychotics in depression complicated by psychosis or agitation has not yet been well studied. This article will review relevant data and make recommendations for the emergency management of psychotic and agitated depressive syndromes.- - - - - - - - - - ranking = 2.5211698370105keywords = psychosis, depression (Clic here for more details about this article) |
7/27. Restlessness related to SSRI withdrawal.There are reports that abrupt withdrawal of various selective serotonin re-uptake inhibitors, such as fluvoxamine, can elicit in patients various withdrawal symptoms. fluvoxamine has been widely used in japan for approximately 1 year. However, there have been no case reports of withdrawal symptoms following abrupt fluvoxamine discontinuation in japan. The author reports a case where the abrupt discontinuation of fluvoxamine produced restlessness in a depressed patient. The restlessness disappeared soon after the reinstatement of treatment with fluvoxamine. This case report suggests that clinicians should carefully scrutinize a patient's compliance to fluvoxamine as the withdrawal symptoms observed following abrupt discontinuation might be regarded as a relapse of depression or side-effects of the medicine.- - - - - - - - - - ranking = 0.21186163950175keywords = depression (Clic here for more details about this article) |
8/27. dementia with lewy bodies treated with rivastigmine: effects on cognition, neuropsychiatric symptoms, and sleep.dementia with lewy bodies (DLB) is a common cause of the dementia syndrome. Symptomatic treatment of the fluctuating cognition, visual hallucinations, and sleep disturbance that characterize this condition is challenging; neuroleptics are relatively contraindicated. We describe eight patients fulfilling the consensus diagnostic criteria for probable DLB who were treated with rivastigmine. Clinical features rated were: cognition by the Modified Mini-Mental State Examination (3MS); and behavioral and psychiatric symptoms by the Neuropsychiatric Inventory (NPI). Additional information was obtained from family and nursing reports. Seven patients showed resolution or improvement in cognition and neuropsychiatric symptoms as demonstrated by improvement in their 3MS and NPI scores. They also became more independent in mobility and activities of daily living, and the majority returned to live in their own home. Of the seven patients with sleep disruption, six improved. One case had no improvement in his symptomatology and the rivastigmine was stopped. Outcomes in this case series suggest that rivastigmine is well tolerated in clinical practice.- - - - - - - - - - ranking = 0.0011694897541552keywords = major (Clic here for more details about this article) |
9/27. brain tumor and psychiatric manifestations: a case report and brief review.brain tumors may present multiple psychiatric symptoms such as depression, personality change, abulia, auditory and visual hallucinations, mania, panic attacks, or amnesia. A case of a 79-year-old woman who presented with depressive symptoms but showed minimal neurological signs and symptoms is discussed. neuroimaging revealed a brain tumor in the left parietal lobe, and patient underwent neurosurgical treatment and subsequently received chemotherapy and radiation. Some patients with neurologically silent brain tumors may present with psychiatric symptoms only. Therefore, we emphasize the consideration of neuroimaging in patients with a change in mental status regardless of a lack of neurological symptoms.- - - - - - - - - - ranking = 0.21186163950175keywords = depression (Clic here for more details about this article) |
10/27. Clinical findings and cytogenetic analysis of small supernumerary ring chromosomes 7: report of two new cases.Two new patients, mosaic for a small supernumerary ring chromosome 7 are described. There are only seven published reported concerning supernumerary ring chromosome 7 and we reviewed the previously reported cases in an attempt to establish genotype-phenotype correlations, which are particularly important for genetic counselling and clinical genetics. Our first case was a 20 months old girl who was referred for a mild motor developmental delay, an asymmetric facial appearance, a plagiocephaly and a short nose with anteverted nostrils. Our second case was a 9 years old boy who was referred for a IQ at the lower end of the normal range (? 80), obesity, hyperactivity and some dysmorphic features including hypertelorism and down slanting palpebral fissures. In both cases, chromosome analysis after G and R banding and FISH showed a small ring chromosome 7 in respectively 76% and 50% of consecutively scored metaphases. Both ring chromosomes were labelled by FISH using the williams syndrome locus probe (elastin Gene D7S486). Comparison between these two cases and previously published cases allowed to delineate frequent clinical findings. A mild mental retardation was found in the majority of patients. which is an important data for genetic counselling.- - - - - - - - - - ranking = 0.0011694897541552keywords = major (Clic here for more details about this article) |
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