October 2017 - Page 16 of 22 - searchfortruth.info

How to Keep Out Unwanted Guests at Family Funerals

November 24, 2018October 10, 2017 by admin

Are Funerals Public or Private?

When planning a wedding, it's easy to ban unwanted family members — simply don't invite them. The bride and groom, bride and bride, or groom and groom (and possibly their parents) get to choose who does and doesn't share the special day. No invitation = no entry.

But what about funerals? Although they are also highly personal occasions, they typically are wide open. Anyone and everyone who knew the deceased could come and pay their respects.

If you are in the position of planning a funeral or memorial service for a loved one, you have a lot to do in a short amount of time. If there have been estrangements, feuds, or tensions within the family, you have those to contend with as well.

Here are some questions to ask yourself:

Can you restrict attendance? Should you restrict attendance? What if the person you don't want at the funeral is...

Opioid Overdose Prevention for Law Enforcement and First Responders

February 21, 2019October 10, 2017 by admin

What is naloxone?
Naloxone is a medication designed to rapidly reverse opioid overdose. It is an opioid antagonist meaning that it binds to opioid receptors and can reverse and block the effects of other opioids. It can very quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain medications.

How is naloxone given?
There are three FDA-approved formulations of naloxone:

Injectable (professional training required)
Generic brands of injectable naloxone vials are offered by a variety of companies that are listed in the FDA Orange Book under "naloxone" (look for "injectable").

Note: There has been widespread use of improvised emergency kits that combine an injectable formulation of naloxone with an atomizer that can deliver naloxone intranasally. Use of this product requires the user to be trained on proper assembly a...

See Also: Opioid Overdose Reversal with Naloxone (Narcan, Evzio)

The Thyroid and the Mind and Emotions | Thyroid Dysfunction and Mental Disorders

November 24, 2018October 10, 2017 by admin

The Thyroid and the Mind and Emotions

Summary of an address to the Kitchener-Waterloo Area Chapter

The psychiatric disturbances which accompany hyperthyroidism and hypothyroidism, the two commonest thyroid disorders, mimic mental illness. People with an overactive thyroid may exhibit marked anxiety and tension, emotional lability, impatience and irritability, distractible overactivity, exaggerated sensitivity to noise, and fluctuating depression with sadness and problems with sleep and the appetite. In extreme cases, they may appear schizophrenic, losing touch with reality and becoming delirious or hallucinating. An underactive thyroid can lead to progressive loss of interest and initiative, slowing of mental processes, poor memory for recent events, fading of the personality's colour and vivacity, general intellectual deterioration, depression with a paranoid flavour, and eventually, if not checked, to dementia and permanent harmful effects on the brain. In instances of each condition, some persons have been wrongly diagnosed, hospitalized for months, and treated unsuccessfully for psychosis....

Hyperkalemia in Emergency Medicine

January 22, 2019October 10, 2017 by admin

Practice Essentials

Hyperkalemia can be difficult to diagnose clinically because symptoms may be vague or absent. The fact, however, that hyperkalemia can lead to sudden death from cardiac arrhythmias requires that physicians be quick to consider hyperkalemia in patients who are at risk for it. See the electrocardiogram below.

Widened QRS complexes in hyperkalemia. See also Can't-Miss ECG Findings, Life-Threatening Conditions: Slideshow, a Critical Images slideshow, to help recognize the conditions shown in various tracings.

Signs and symptoms

Patients with hyperkalemia may be asymptomatic, or they may report the following symptoms (cardiac and neurologic symptoms predominate):

• Generalized fatigue
• Weakness
• Paresthesias
• Paralysis
• Palpitations

Hyperkalemia (High Blood Potassium)

November 24, 2018October 10, 2017 by admin

What is hyperkalemia? Hyperkalemia is a common diagnosis. Fortunately, most patients who are diagnosed have mild hyperkalemia (which is usually well tolerated). However, any condition causing even mild hyperkalemia should be treated to prevent progression into more severe hyperkalemia. Extremely high levels of potassium in the blood (severe hyperkalemia) can lead to cardiac arrestand death. When not recognized and treated properly, severe hyperkalemia results in a high mortality rate.

Technically, hyperkalemia means an abnormally elevated level of potassium in the blood. The normal potassium level in the blood is 3.5-5.0 milliequivalents per liter (mEq/L). Potassium levels between 5.1 mEq/L to 6.0 mEq/L reflect mild hyperkalemia. Potassium levels of 6.1 mEq/L to 7.0 mEq/L are moderate hyperkalemia, and levels above 7 mEq/L are severe hyperkalemia.

How does hyperkalemia affect the body?

Potassium is critical for the normal functioning of the muscles, heart, and nerves....

Hypothyroidism: An Important Diagnostic Consideration for the Psychiatrist

November 24, 2018October 10, 2017 by admin

Hypothyroidism is a clinical state of thyroid hormone deficiency that may have a primary or secondary (central) cause. Primary hypothyroidism, which is more common than secondary hypothyroidism, is defined as failure of the thyroid gland to respond appropriately to thyroid-stimulating hormone (TSH) produced in the anterior pituitary gland. Primary hypothyroidism can be caused by autoimmune disease (Hashimoto disease), iodine deficiency, or infiltrative diseases, or it can be caused iatrogenically by surgery or irradiation of the gland. Subclinical hypothyroidism refers to mildly increased TSH levels in the setting of normal thyroxine (T4) and triiodothyronine (T3) levels. Secondary hypothyroidism is defined as insufficient thyroid gland stimulation by the hypothalamus or pituitary gland.

What new information does this article provide?

This article provides a simple and concise review of the varied physical and neuropsychiatric presentations of hypothyroidism and important diagnostic and treatment information.

What are the implications for psychiatric practice?

Hypothyroidism presents with a myriad of neuropsychiatric...

Mechanisms Of Fatal Opioid Overdose.

November 24, 2018October 10, 2017 by admin

Abstract

There has been increasing recognition of the problem of fatal opioid overdose. This review examines the pharmacological basis of respiratory depression following opioid administration. Respiration is controlled principally through medullary respiratory centres with peripheral input from chemoreceptors and other sources. Opioids produce inhibition at the chemoreceptors via mu opioid receptors and in the medulla via mu and delta receptors. While there are a number of neurotransmitters mediating the control of respiration, glutamate and GABA are the major excitatory and inhibitory neurotransmitters, respectively. This explains the potential for interaction of opioids with benzodiazepines and alcohol: both benzodiazepines and alcohol facilitate the inhibitory effect of GABA at the GABAA receptor, while alcohol also decreases the excitatory effect of glutamate at NMDA receptors. Heroin and methadone are the major opioids implicated in fatal overdose. Heroin has three metabolites with opioid activity. Variation in the formation of these metabolites due to genetic factors and the use...

Clinical Manual of Pain Management in Psychiatry

November 24, 2018October 10, 2017 by admin

While recognizing the multidisciplinary nature of pain management, the Clinical Manual of Pain Management in Psychiatry focuses on the role of mental health practitioners in evaluation and assessment, pharmacological management, psychotherapeutic interventions, and comprehensive treatment planning. It balances theoretical foundations of pain pathophysiology with applied clinical information, providing guidelines to psychiatric differential diagnosis of pain states and psychiatric comorbidities associated with pain and integrating diagnostic and treatment approaches. Because proper treatment requires understanding the whole person, the book views the patient from biological, psychological, and social perspectives. It stresses the importance of examining psychological variables that can limit outcomes and even preclude aggressive interventional approaches. The manual also includes considerations pertinent to the elderly, children, and cultural groups.

This manual expands on the author's previous Concise Guide to Pain Management for Psychiatrists to reflect significant advances in the field of pain medicine. It updates trends in treatment approaches along...

Drug-Induced Orthostatic Hypotension.

November 24, 2018October 10, 2017 by admin

Abstract

Drug-induced orthostatic hypotension is an important clinical problem. When symptomatic, it is poorly tolerated by the patient, and can be a cause for discontinuing treatment. It may have more serious consequences if it leads to syncope, falls and injury, or to sustained loss of perfusion of vital organs resulting in heart attack or stroke. Orthostatic hypotension is easily detected by procedures available to all physicians, who should maintain a high index of suspicion when prescribing drugs commonly known to cause this condition, especially in the elderly. Since the medical conditions calling for the use of these drugs are extremely prevalent, the screening and monitoring of orthostatic hypotension should be instituted as a routine precaution in appropriate patients. Hypertension affects two-thirds of elderly patients. Orthostatic hypotension is an infrequent adverse effect of most of the drugs in current use in the treatment of hypertension; it is, however,...

Excited Delirium Strikes Without Warning

November 24, 2018October 9, 2017 by admin

Learning Objective

• Discuss the pathophysiology of excited delirium • Recognize the signs and symptoms excited delirium • Identify the treatment for a patient presenting with excited delirium

Key Terms

Bells Mania: A condition that manifests with mania and fever in which the patient becomes exhausted due to mental excitement. Benzodiazepine: A medication that results in sedative, hypnotic, anxiolytic, anticonvulsant, muscle relaxant and amnesic action. Dissociative agents: Medications that produce a trance-like state by causing interruption of cerebral association pathways between the limbic and cortical systems. Dopamine: A catecholamine neurotransmitter produced in several areas of the brain, including the substantia nigra. Excited delirium: A condition that manifests as a combination of delirium, psychomotor agitation, anxiety, hallucinations, speech disturbances, disorientation, violent and bizarre behavior, insensitivity to pain, elevated body temperature and superhuman strength. Neuroleptic malignant syndrome: A condition that causes delirium and death as a result of abrupt withdrawal from psychiatric medication that blocks dopamine re-uptake....

Variability of Undetermined Manner of Death Classification in the US

November 24, 2018October 9, 2017 by admin

Abstract

OBJECTIVES: To better understand variations in classification of deaths of undetermined intent among states in the National Violent Death Reporting System (NVDRS). DESIGN: Data from the NVDRS and the National Vital Statistics System were used to compare differences among states. MAIN OUTCOME MEASURES: Percentages of deaths assigned undetermined intent, rates of deaths of undetermined intent, rates of fatal poisonings broken down by cause of death, composition of poison types within the undetermined-intent classification. RESULTS: Three states within NVDRS (Maryland, Massachusetts, and Rhode Island) evidenced increased numbers of deaths of undetermined intent. These same states exhibited high rates of undetermined death and, more specifically, high rates of undetermined poisoning deaths. Further, these three states evidenced correspondingly lower rates of unintentional poisonings. The types of undetermined poisonings present in these states, but not present in other states, are typically the result of a combination of recreational drugs, alcohol, or prescription drugs. CONCLUSIONS:...

Lobotomy | Catholic Physicians’ Guild July 1948

February 21, 2019October 9, 2017 by admin

LOBOTOMY

Question: Is prefrontal lobotomy morally permissible in the treatment of mental disorders? Principle The principle to be applied in answering the question is this: Any procedure harmful to the patient is morally justifiable only in so far as it is designed to produce a proportionate good. As long as we remain in the sphere of theory this principle is easily explained and easily understood. It simply means that to pass judgment on the morality of any mutilation one must compare the harm that might be done with the benefit to be expected. If the hope of benefit is commensurate with the danger of harm, the procedure is morally justifiable; otherwise it is not. But when we pass from theory,to the judging of a particular procedure for a particular patient, we are often confronted with many difficulties. To make a fair comparison of harm...

Excited Delirium

November 24, 2018October 9, 2017 by admin

Abstract

Excited (or agitated) delirium is characterized by agitation, aggression, acute distress and sudden death, often in the pre-hospital care setting. It is typically associated with the use of drugs that alter dopamine processing, hyperthermia, and, most notably, sometimes with death of the affected person in the custody of law enforcement. Subjects typically die from cardiopulmonary arrest, although the cause is debated. Unfortunately an adequate treatment plan has yet to be established, in part due to the fact that most patients die before hospital arrival. While there is still much to be discovered about the pathophysiology and treatment, it is hoped that this extensive review will provide both police and medical personnel with the information necessary to recognize and respond appropriately to excited delirium...

The Karpman Drama Triangle

November 24, 2018October 9, 2017 by admin

The basic concept underpinning the Karpman Drama Triangle is the connection between responsibility and power, and their relationship to boundaries.

The Karpman Drama Triangle was originally conceived by Steven Karpman and was used to plot the interplay and behavioural “moves” between two or more people. Karpman’s original premise was based on the Transactional Analysis model as proposed by Eric Berne in the 50’s. Berne’s hypothesis is that people form a “Script” which is essentially an individual’s concept or belief about who they are, what the World is like, how they relate to the World, how the World relates to them, and how others treat them. Psychologists theorise that an individual forms their Script by the time they are four or five. A Script is based on what an individual is told, what they experience, and how they interpret these external stimuli from their own internal frame of reference....

Are You a Victim of the Victim Syndrome?

November 24, 2018October 9, 2017 by admin

Abstract

People who suffer from the victim syndrome are always complaining about the 'bad things that happen' in their lives. Because they believe they have no control over the way events unfold, they don’t feel a sense of responsibility for them. One moment, they present themselves dramatically as victims; the next, they morph into victimizers, hurting the people trying to help them and leaving would-be helpers with a sense of utter frustration. People with a victim mentality display passive-aggressive characteristics when interacting with others. Their behavior has a self-defeating, almost masochistic quality. The victim style becomes a relational mode - a life affirming activity: I am miserable therefore I am. In this article, I present three examples of people with this syndrome and a checklist that can be used to identify sufferers. I also discuss the concept of secondary gain - the 'benefits' people get from perpetuating a problem... .

The Management of Thoracic Injuries

February 21, 2019October 9, 2017 by admin

WITH THE roads daily becoming choked with fast cars, Casualty Departments throughout the country are increasingly familiar with major chest injuries. The crushing forces applied to the chest as the driver is thrown against the steering column, and the stresses imposed upon mediastinal structures by rapid deceleration in head-on collision often produce injuries so severe that death is instantaneous. In those fortunate enough to reach hospital, resuscitative measures must be applied immediately and often by doctors untrained in thoracic surgery. London (1963) found ninetythree chest injuries in a series of 551 casualties admitted to the Birmingham Accident Hospital, and of these, sixty-eight had other important lesions. The principles underlying the management of thoracic trauma are straightforward and their application involves only a few easily acquired techniques. Abrams (1961a) succinctly defined the causes of death from chest injury as 'the lethal triad, bleeding, drowning and suffocation',...