searchfortruth.info > Blog > Page 85

Clinical Manual of Pain Management in Psychiatry

by

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...

Read More!

Mechanisms Of Fatal Opioid Overdose.

by

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...

Read More!

Hypothyroidism: An Important Diagnostic Consideration for the Psychiatrist

by

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...

Read More!

Hyperkalemia (High Blood Potassium)

by

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....

Read More!

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

by

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....

Read More!

How to Keep Out Unwanted Guests at Family Funerals

by

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...  

Read More!

Is Succinylcholine Really Superior for RSI?

by

Background:

Intubation is arguably the most important procedure performed by Emergency Physicians (EPs). Ideally, it would be performed successfully on the first attempt each and every time, but this of course cannot always be the case. Rapid Sequence Intubation (RSI) has become the preferred method for emergency intubations, as it improves visualization of the vocal cords, and decreases complications such as aspiration and increased intracranial pressure. Succinylcholine, a depolarizing agent, is the most widely utilized paralytic due to its rapid onset and short half-life. However, there are certain circumstances in which succinylcholine is contraindicated, including suspected hyperkalemia, known prior adverse reactions, concern for head injury, neuromuscular disease, or spinal cord injury. Rocuronium, a non-depolarizing agent with a considerably longer half-life, is frequently used in these situations.

Prior studies evaluated by the Cochrane review suggest succinylcholine produces superior intubation conditions when compared to rocuronium.[1]However, there is concern that succinylcholine's advantage...

Read More!

Extended Release Drug Delivery Strategies in Psychiatry

by

Abstract

Objective: An overview of the emerging field of long-term delivery strategies for improved convenience and adherence with psychiatric medications is provided. This review is motivated by the hypothesis that adherence to treatment is an important determinant of clinical outcomes in a wide range of settings and is particularly important in psychiatry practice where patients require treatment for months or years and premature discontinuation can have serious consequences for patient health and quality of life.

Design: The author reviews the relevant literature and highlights several approaches to providing improved access to continuous medication through new and innovative delivery strategies ranging from days to annual intervals.

Benefits and Disadvantages: Several solutions to the problem of discontinuous access to pharmacotherapy are being developed in the form of new, long-acting drug-delivery systems, which gradually release medication over a period of several days or weeks with a single application. Long-acting formulations of psychiatric medications offer...

Read More!

Fluoxetine Delayed Release Capsules

by

WARNING: SUICIDAL THOUGHTS AND BEHAVIOR

 Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk with antidepressant use in patients aged 65 and older [see Warnings and Precautions (5.1)].  psy

In patients of all ages who are started on antidepressant therapy, monitor closely for worsening and for emergence of suicidal thoughts and behaviors. Advise families and caregivers of the need for close observation and communication with the prescriber [see Warnings and Precautions (5.1).

Fluoxetine is not approved for use in children less than 7 years of age [see Warnings and Precautions (5.1) and Use in Specific Populations (8.4)].  Indications and Usage for Fluoxetine Delayed Release Capsules

Fluoxetine delayed-release capsules are indicated for the treatment of: ...

Read More!

The Surgical Hypertensive Patient

by

Abstract

We reviewed the pathophysiology and treatment of hypertension in a recent edition of this journal (see key references). In this article, we discuss the management of the hypertensive patient presenting for surgery and anaesthesia.

Key points

Arterial hypertension is a risk factor for cardiovascular complications after anaesthesia and surgery.

Ideally, all hypertensive patients should be treated before elective surgery; in practice only patients with stage 3 (systolic >180 mm Hg; diastolic >110 mm Hg) are regarded as needing preoperative treatment.

The importance of isolated systolic hypertension in the surgical patient is not well defined.

Patients with moderate hypertension (stage 2) but significant target organ involvement should be considered for preoperative treatment.

Most antihypertensive agents do not have adverse interactions with anaesthetic agents and should be continued throughout the perioperative period except for ACE inhibitors and angiotensin II receptor antagonists where the evidence for continuation or cessation is unclear..

Read More!

Crisis Management During Anaesthesia: Pulmonary Oedema

by

Abstract

Background: Pulmonary oedema may complicate the perioperative period and the aetiology may be different from non-operative patients. Diagnosis may be difficult during anaesthesia and consequently management may be delayed.

Objectives: To examine the role of a previously described core algorithm “COVER ABCD–A SWIFT CHECK”, supplemented by a specific sub-algorithm for pulmonary oedema, in its management occurring in association with anaesthesia.

Methods: The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved.

Results: Pulmonary oedema was identified in 35 (<1%) of the first 4000 reports to AIMS. The most frequent presenting sign was hypoxia (46%) and the most specific sign was the presence of frothy sputum (23%). The core algorithm, although successful in the management of the initial physiological upset,...

Read More!

Pulmonary Edema And Hemorrhage As Complications Of Acute Airway Obstruction Following Anesthesia.

by

Abstract

Airway obstruction is a quite common complication while its conditioned pulmonary edema--rare. Causes associated with anesthesia are various. Forced inspiratory efforts against an obstructed upper airway generate peak negative intrathoracic pressure. This may cause pulmonary edema and in some cases pulmonary hemorrhage. Last-mentioned is extremely rare. Pulmonary edema may arise soon after airway obstruction as well as later, after some hours. Damage of bronchi is found seldom during bronchoscopy in case of pulmonary hemorrhage, while more often alveolar damage is observed due to alveolar membrane damage. Hemorrhage is conditioned by hydrostatic pressure level, level of hypoxia, damage to bronchi or alveoli (disruption of alveolar membrane). Early diagnosis of negative-pressure pulmonary edema or pulmonary hemorrhage is very important, because this affects postoperative morbidity and mortality of the patients. Two cases of pulmonary edema and hemorrhage after upper airway obstruction as well as literature overview are presented in this article. Pulmonary hemorrhage developed during anesthesia...

Read More!

Understanding and Managing Compulsive Sexual Behaviors

by

Abstract

Compulsive sexual behavior, otherwise known as sexual addiction, is an emerging psychiatric disorder that has significant medical and psychiatric consequences. Until recently, very little empirical data existed to explain the biological, psychological, and social risk factors that contribute to this condition. In addition, clinical issues, such as the natural course and best practices on treating sexual addictions, have not been formalized. Despite this absence, the number of patients and communities requesting assistance with this problem remains significant. This article will review the clinical features of compulsive sexual behavior and will summarize the current evidence for psychological and pharmacological treatment.

Introduction

Sexuality in the United States has never been more socially acceptable. Sex has become part of mainstream culture as reflected through the explicit coverage of sexual behaviors in the media, movies, newspapers, and magazines. In many ways, sexual expression has become a form of accepted entertainment similar to gambling, attending sporting events,..

Read More!

Noise, Noise Sensitivity And Psychiatric Disorder: Epidemiological And Psychophysiological Studies.

by

Abstract

Noise, a prototypical environmental stressor, has clear health effects in causing hearing loss but other health effects are less evident. Noise exposure may lead to minor emotional symptoms but the evidence of elevated levels of aircraft noise leading to psychiatric hospital admissions and psychiatric disorder in the community is contradictory. Despite this there are well documented associations between noise exposure and changes in performance, sleep disturbance and emotional reactions such as annoyance. Moreover, annoyance is associated with both environmental noise level and psychological and physical symptoms, psychiatric disorder and use of health services. It seems likely that existing psychiatric disorder contributes to high levels of annoyance. However, there is also the possibility that tendency to annoyance may be a risk factor for psychiatric morbidity. Although noise level explains a significant proportion of the variance in annoyance, the other major factor, confirmed in many studies,..

Read More!

Learned Helplessness: Theory and Evidence

by

Abstract

Reviews the literature which examined the effects of exposing organisms to aversive events which they cannot control. Motivational, cognitive, and emotional effects of uncontrollability are examined. It is hypothesized that when events are uncontrollable the organism learns that its behavior and outcomes are independent, and this learning produces the motivational, cognitive, and emotional effects of uncontrollability. Research hich supports this learned helplessness hypothesis is described along with alternative hypotheses which have been offered as explanations of the learned helplessness effect. The application of this hypothesis to rats and man is examined...

Read More!

Central Nervous System Stimulants And Sport Practice

by

Abstract

Background and objectives

Central nervous system (CNS) stimulants may be used to reduce tiredness and increase alertness, competitiveness, and aggression. They are more likely to be used in competition but may be used during training to increase the intensity of the training session. There are several potential dangers involving their misuse in contact sports. This paper reviews the three main CNS stimulants, ephedrine, amfetamine, and cocaine, in relation to misuse in sport.

Methods

Description of the pharmacology, actions, and side effects of amfetamine, cocaine, and ephedrine.

Results

CNS stimulants have psychotropic effects that may be perceived to be ergogenic. Some are prescription drugs, such as Ephedra alkaloids, and there are issues regarding their appropriate therapeutic use. Recently attention has been given to their widespread use by athletes, despite the lack of evidence regarding any ergogenic or real performance benefit, and their potentially serious side effects. Recreational drugs, some of which are illegal (cocaine, amfetamines), are commonly...

Read More!