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6 results

  • 3.4.6 - Delirium

  • from Section 3.4 - Neurological Impairment and Injury
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 194-196

  • Summary

    Key Learning Points

    1. 1. Delirium is an independent predictor of poor patient outcomes.

    2. 2. Routine daily screening for delirium is essential.

    3. 3. Daily targeted light sedation reduces the risk of delirium.

    4. 4. Early mobilisation needs to be a priority.

    5. 5. Only use anti-psychotics to reduce symptoms of agitation.

  • 21b - Considerations Regarding the Pharmacological Management of Personality Disorders: Commentary on Recent Developments in the Pharmacologic Management of Personality Disorders

  • from Part V - Treatment
  • Edited by Carl W. Lejuez, University of Kansas, Kim L. Gratz, University of Toledo, Ohio
  • Book:
    The Cambridge Handbook of Personality Disorders
    Published online:
    24 February 2020
    Print publication:
    07 May 2020, pp 517-520

  • Summary

    Despite the advancements in the development of pharmacological interventions for personality disorders (PDs), clinicians should be relatively cautious about the potential benefits of using pharmacological agents for the treatment of PDs when facing therapeutic decisions for individual patients. The pharmacological management of PDs is considerably complex; frequent treatment drop-out, non-compliance, and adverse effects illustrate why having a good therapeutic relationship with patients is a particularly important factor for the success of pharmacological treatment of PDs. Results from clinical trials for PDs may not be generalizable for individual patients in the community. PDs are heterogeneous conditions associated with many psychiatric disorders. Yet, clinical trials frequently include highly selected populations that do not necessarily correspond to typical patients with PDs found in community settings. Considering that PDsfrequently co-occur with other psychiatric diagnoses, a promising approach to future research in PDs should consider the development of treatment algorithms based on co-occurring disorders. This approach is likely to resonate with prescribing physicians trained to evaluate patients systematically for the presence or absence of specific disorders. For instance, this approach has been increasingly studied in gambling disorder, with promising findings reported thus far.

  • Patterns of psychotropic prescribing and polypharmacy in older hospitalized patients in Ireland: the influence of dementia on prescribing

  • Kieran Anthony Walsh, Niamh A. O'Regan, Stephen Byrne, John Browne, David J. Meagher, Suzanne Timmons
  • Journal:
    International Psychogeriatrics / Volume 28 / Issue 11 / November 2016
    Published online by Cambridge University Press:
    16 August 2016, pp. 1807-1820
    • Article
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  • Background:

    Neuropsychiatric Symptoms (NPS) are ubiquitous in dementia and are often treated pharmacologically. The objectives of this study were to describe the use of psychotropic, anti-cholinergic, and deliriogenic medications and to identify the prevalence of polypharmacy and psychotropic polypharmacy, among older hospitalized patients in Ireland, with and without dementia.

    Methods:

    All older patients (≥ 70 years old) that had elective or emergency admissions to six Irish study hospitals were eligible for inclusion in a longitudinal observational study. Of 676 eligible patients, 598 patients were recruited and diagnosed as having dementia, or not, by medical experts. These 598 patients were assessed for delirium, medication use, co-morbidity, functional ability, and nutritional status. We conducted a retrospective cross-sectional analysis of medication data on admission for 583/598 patients with complete medication data, and controlled for age, sex, and co-morbidity.

    Results:

    Of 149 patients diagnosed with dementia, only 53 had a previous diagnosis. At hospital admission, 458/583 patients experienced polypharmacy (≥ 5 medications). People with dementia (PwD) were significantly more likely to be prescribed at least one psychotropic medication than patients without dementia (99/147 vs. 182/436; p < 0.001). PwD were also more likely to experience psychotropic polypharmacy (≥ two psychotropics) than those without dementia (54/147 vs. 61/436; p < 0.001). There were no significant differences in the prescribing patterns of anti-cholinergics (23/147 vs. 42/436; p = 0.18) or deliriogenics (79/147 vs. 235/436; p = 0.62).

    Conclusions:

    Polypharmacy and psychotropic drug use is highly prevalent in older Irish hospitalized patients, especially in PwD. Hospital admission presents an ideal time for medication reviews in PwD.

  • A naturalistic study of pharmacological management of behavioural disturbance in psychosis

  • Steve Addis, Diane Sherwood, Wendy Mace, Serafino G. Mancuso, Radhakrishnan Koloth, David J. Castle
  • Journal:
    Journal of Psychiatric Intensive Care / Volume 8 / Issue 2 / August 2012
    Published online by Cambridge University Press:
    28 March 2012, pp. 120-125
    Print publication:
    August 2012

  • Objective: To explore, using a naturalistic design, the efficacy of typical and atypical antipsychotics in the management of behavioural disturbance in people with psychiatric disorders.

    Method: Prospective naturalistic study of 15,278 incidents of behavioural disturbance perpetrated by 1,059 patients, over a two year period.

    Results: Typical and atypical antipsychotics did not differ in terms of their efficacy, overall. In terms of specific agents, haloperidol and quetiapine tended to show equal efficacy, with olanzapine being somewhat less effective on two of three outcome measures.

    Conclusions: Overall, atypical antipsychotics were as effective as typical agents in the management of acute behavioural disturbance in a mental health setting. Further work is required to determine the relative side effect burden of those agents.

  • Treatment of schizophrenia complicated by catatonia with clozapine in a 16 year old asylum seeker

  • Ted Agadagba, Gordon Bates
  • Journal:
    Journal of Psychiatric Intensive Care / Volume 8 / Issue 1 / April 2012
    Published online by Cambridge University Press:
    03 March 2011, pp. 47-53
    Print publication:
    April 2012

  • In this case report, we describe the clinical course of a 16 yr old asylum seeker from Afghanistan who developed paranoid schizophrenia complicated by catatonia and was successfully treated with diazepam and clozapine. To our knowledge, this is the first case report of its kind in this age group.

    Our patient became psychotic and presented to A&E after cutting off the tip of his nose in response to command hallucinations telling him to kill himself, his mother and his siblings. His catatonic features, which emerged after hospitalization, were those of mutism, akinesia, posturing including the psychological pillow. He did not respond to risperidone or haloperidol; showed a partial response to lorazepam and diazepam. His catatonic features and psychosis only resolved upon the introduction of clozapine.

    We go on to review the literature about catatonia in children and adolescents. We discuss the nosological dilemma with classification, the evolution of treatments and the role of anti-psychotic medication in the treatment of catatonia. Specifically, we advocate the usefulness of clozapine as an adjunct and as monotherapy.