1/3. 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 = 1keywords = physician (Clic here for more details about this article) |
2/3. risperidone treatment of motor restlessness following anoxic brain injury.PRIMARY OBJECTIVE: This paper examined the use of an atypical neuroleptic medication, risperidone, in reducing the excessive motor activity of an adolescent with an anoxic brain injury following cardiac arrest from a lightning strike. lower extremity restlessness caused the patient to develop skin breakdown and interfered with healing of existing burns. research design: Single-blind, placebo-controlled single-subject experimental design. EXPERIMENTAL INTERVENTION: Escalating doses of risperidone up to 1 mg and in combination with methylphenidate (10 mg) and amantidine (100 mg). MAIN OUTCOMES AND RESULTS: The patient demonstrated a reduction in restlessness in response to the use of risperidone, which permitted wound healing. The addition of methlphenidate to risperidone led to a slight increase in attention to task. CONCLUSIONS: The use of the atypical neuroleptic medication, risperidone, may be considered as part of the armamentarium available to physicians treating restlessness in severe brain injuries.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/3. Agitation observed during treatment with newer hypnotic drugs.Side effects involving agitation, e.g., sleepwalking, anger, and panic, were observed in 10 insomniac patients treated with temazepam or triazolam but not other benzodiazepines. Each patient described these side effects as uncharacteristic. Milder agitation was observed in 2 cases. In 4 cases, these effects were doubted by the prescribing physician. This type of side effect has been only slowly recognized for other benzodiazepines and has not been much reported for these newer agents. Agitation observed during treatment with these agents may be related to their short elimination half-lives.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |