scholarly journals Iatrogenic delirium on symptom-triggered alcohol withdrawal protocol

2020 ◽  
Vol 12 (1) ◽  
pp. 23-25 ◽  
Author(s):  
Andrew Chunkil Park ◽  
Leigh Goodrich ◽  
Bobak Hedayati ◽  
Ralph Albert ◽  
Kyle Dornhofer ◽  
...  
Keyword(s):  
Alcohol Withdrawal ◽  
Treatment Duration ◽  
Treatment Options ◽  
Alcohol Withdrawal Syndrome ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Content Type ◽  
Assessment And Treatment ◽  
Antiepileptic Medications ◽  
Confusional States

Purpose The purpose of this paper is to illustrate delirium as a possible consequence of the application of symptom-triggered therapy for alcohol withdrawal and to explore alternative treatment modalities. In the management of alcohol withdrawal syndrome, symptom-triggered therapy directs nursing staff to regularly assess patients using standardized instruments, such as the Clinical Institute for Withdrawal Assessment of Alcohol, Revised (CIWA-Ar), and administer benzodiazepines at symptom severity thresholds. Symptom-triggered therapy has been shown to lower total benzodiazepine dosage and treatment duration relative to fixed dosage tapers (Daeppen et al., 2002). However, CIWA-Ar has important limitations. Because of its reliance on patient reporting, it is inappropriate for nonverbal patients, non-English speakers (in the absence of readily available translators) and patients in confusional states including delirium and psychosis. Importantly, it also relies on the appropriate selection of patients and considering alternate etiologies for signs and symptoms also associated with alcohol withdrawal. Design/methodology/approach The authors report a case of a 47-year-old male admitted for cardiac arrest because of benzodiazepine and alcohol overdose who developed worsening delirium on CIWA-Ar protocol. Findings While symptom-triggered therapy through instruments such as the CIWA-Ar protocol has shown to lower total benzodiazepine dosage and treatment duration in patients in alcohol withdrawal, over-reliance on such tools may also lead providers to overlook other causes of delirium. Originality/value This case illustrates the necessity for providers to consider using other available assessment and treatment options including objective alcohol withdrawal scales, fixed benzodiazepine dosage tapers and even antiepileptic medications in select patients.

Irritable Bowel Syndrome with Diarrhea

2018 ◽  
Author(s):  
Judy Nee ◽  
Jacqueline L. Wolf
Keyword(s):  
Irritable Bowel Syndrome ◽  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Dietary Advice ◽  
Emerging Therapies ◽  
Irritable Bowel

Irritable bowel syndrome (IBS) is a complex, functional gastrointestinal condition characterized by abdominal pain and alteration in bowel habits without an organic cause. One of the subcategories of this disorder is IBS with diarrhea (IBS-D). Clinically, patients who present with more than 3 months of abdominal pain or discomfort associated with an increase in stool frequency and/or loose stool form are defined as having IBS-D. This review addresses IBS-D, detailing the epidemiology, etiology and genetics, pathophysiology and pathogenesis, diagnosis, clinical manifestations and physical examination findings, differential diagnosis, treatment, emerging therapies, complications, and prognosis. Figures show potential mechanisms and pathophysiology of IBS, IBS-D suspected by clinical assessment and Rome III criteria, pharmacologic and nonpharmacologic treatment options, potential mechanisms of action of probiotics, and potential treatment modalities. Tables list the Rome criteria for IBS, alarm signs and symptoms suggestive of alternative diagnoses, IBS criteria, differential diagnosis of IBS-D, dietary advice options for IBS-D, and alternative and emerging therapies in IBS-D. This review contains 5 figures, 6 tables and 42 references KEYWORDS: IBS-D, eluxadoline, rifaximin, probiotics, bloating, antidepressants, bile acid malabsorption, microscopic colitis, celiac

scholarly journals Symptom Triggered Therapy versus Fixed-Dosed Scheduling for Alcohol Withdrawal: A Systematic Review

2021 ◽  
Author(s):  
Amanda Saucedo
Keyword(s):  
Systematic Review ◽  
Nurse Practitioners ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Alcohol Withdrawal Syndrome ◽  
Treatment Modalities ◽  
Advanced Practice ◽  
Outpatient Basis ◽  
Care Nurse ◽  
Common Diagnosis

Alcohol Use Disorder (AUD) is a significant health problem that is seen widely inall hospitals and in the community. Individuals who have AUD and cease to consume alcohol develop Alcohol Withdrawal Syndrome (AWS). Alcohol Withdrawal Syndrome can either be treated on an inpatient or outpatient basis. Three different pharmacological regimens for treating AWS with medications exist. The three regimens include fixeddosing, symptom-triggered, and loading dose regimens (Sachdeva et al., 2015). As Acute Care Nurse Practitioners (APRNs), AWS will be a common diagnosis treated. Advanced Practice Registered Nurses (APRNs) must be aware of the different treatment modalities and the best evidence-based regimens for treating AWS. The purpose of this project is to conduct a systematic review to determine if the use of symptom-triggered dosing compared to fixed-schedule dosing of benzodiazepines for the treatment of AWS decreases total dosage of benzodiazepines administered during the course of treatment.

From research to practice: a multifaceted and dimensional approach to psychopathy

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Steven W. Steinert ◽  
Sneha Shankar ◽  
Eamonn P. Arble
Keyword(s):  
Dialectical Behavior Therapy ◽  
Treatment Modalities ◽  
Practical Application ◽  
Content Type ◽  
Practical Utility ◽  
Continuous Scale ◽  
Assessment And Treatment ◽  
Correctional Settings ◽  
Intervention Modality ◽  
Practical Implications

Purpose This paper aims to evaluate trends in research and clinical practice that may contribute to the limited utility of assessment and treatment modalities designed to capture and address psychopathy. It identifies a lack of consistency between the academic understanding of psychopathy and how the construct is applied in clinical contexts. The authors provide clarity and direction for a more effective application of the psychopathy construct in practical contexts. Design/methodology/approach This review first examines the etiology of important limitations to psychopathy research and practical application, and proposes the adoption of the most recent empirical conceptualization of the construct into practical contexts. It then evaluates the current functionality of psychopathy in practical contexts. The review ultimately proposes a method for designing intervention practices based on the model used in the development of dialectical behavior therapy (DBT) for borderline personality disorder, which will improve the practical utility of the construct. Findings The present review provides evidence that a multifaceted and dimensional perspective of psychopathy will improve the practical utility of the construct and help move the field forward. It suggests that considering independent components of the psychopathy construct along a continuous scale, as with DBT, will contribute to improvements in assessments and treatments that target psychopathy. Practical implications The current review applies relevant research to a model for developing an intervention modality particularly in forensic or correctional settings where individuals high in psychopathy are often seen. The implications outlined provide a framework that could impact practice and assessment in forensic contexts moving forward. Originality/value Previous research has not concisely outlined problems concerning the link between psychopathy research and how the construct is applied in practical settings. Few researchers have proposed plausible solutions that could improve the utility of the construct in such settings.

Irritable Bowel Syndrome with Diarrhea

2018 ◽  
Author(s):  
Judy Nee ◽  
Jacqueline L. Wolf
Keyword(s):  
Irritable Bowel Syndrome ◽  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Dietary Advice ◽  
Emerging Therapies ◽  
Irritable Bowel

Irritable bowel syndrome (IBS) is a complex, functional gastrointestinal condition characterized by abdominal pain and alteration in bowel habits without an organic cause. One of the subcategories of this disorder is IBS with diarrhea (IBS-D). Clinically, patients who present with more than 3 months of abdominal pain or discomfort associated with an increase in stool frequency and/or loose stool form are defined as having IBS-D. This review addresses IBS-D, detailing the epidemiology, etiology and genetics, pathophysiology and pathogenesis, diagnosis, clinical manifestations and physical examination findings, differential diagnosis, treatment, emerging therapies, complications, and prognosis. Figures show potential mechanisms and pathophysiology of IBS, IBS-D suspected by clinical assessment and Rome III criteria, pharmacologic and nonpharmacologic treatment options, potential mechanisms of action of probiotics, and potential treatment modalities. Tables list the Rome criteria for IBS, alarm signs and symptoms suggestive of alternative diagnoses, IBS criteria, differential diagnosis of IBS-D, dietary advice options for IBS-D, and alternative and emerging therapies in IBS-D. This review contains 5 highly rendered figures, 6 tables, and 99 references. 

Curative effects of Dhatryadi ghrita bioactive extracts on ethanol withdrawal syndrome in Wistar rats

2020 ◽  
Vol 16 ◽  
Author(s):  
Rashmi Saxena Pal ◽  
Amrita Mishra
Keyword(s):  
Locomotor Activity ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Wistar Rats ◽  
Alcohol Withdrawal Syndrome ◽  
Signs And Symptoms ◽  
Normal Diet ◽  
Ethanol Withdrawal ◽  
Control Group ◽  
Alcoholic Extract

Background: Alcohol withdrawal syndrome leads to irritability, aggressiveness, body posture and motor abnormalities, sensory hyper reactivity and changes in various enzyme levels. Dhatryadi ghrita penetrates the blood- brain barrier to decrease the cravings for alcohol in this syndrome. Objective: To evaluate the effect of alcoholic extract of Dhatryadi ghrita on alcohol withdrawal syndrome in Wistar rats. Material & Methods: A liquid diet with 7.2%, v/v ethanol was administered to the Wistar rats for 21 days. Control group animals received saline and normal diet. After alcohol withdrawal, rats were examined at 6th and 24th hour for anxiety and hyper locomotor activity as major withdrawal signs. Anxiety due to ethanol withdrawal was tested with the help of elevated plus maze, light and dark models. The hyper locomotor activity was assessed using Actophotometer. The hepatic enzymes level was determined with the help of the Bio-chemical Analyzer. Ghrita extract (100, 200,300 mg/kg, oral) were administered to different groups and diazepam as standard (2 mg/kg, i.p) were administered to the treatment group animals 30 minutes before alcohol withdrawal estimation. Drug treatment was administered 30 minutes before the second observation at the 24th hour. Results: Findings from the present study revealed that Ghrita extract treatment at doses 100, 200 and 300 mg/kg, oral in ethanol-dependent rats had a significant protective effect on signs and symptoms of ethanol withdrawal in alcohol-dependent rats. Conclusion: Dhatryadi extract acts effectively for the treatment of alcohol abstinence syndrome. The extract treat¬ment has beneficial effects on ethanol withdrawal depressive-like behavior in rats.

Psychiatric Assessment and Treatment Planning

2014 ◽  
Author(s):  
Janis L. Cutler
Keyword(s):  
Treatment Options ◽  
Signs And Symptoms ◽  
Cultural Perspective ◽  
Psychiatric Assessment ◽  
Appropriate Treatment ◽  
Assessment And Treatment ◽  
History Of ◽  
Psychosocial History ◽  
Patient’S History ◽  
Objective Description

This chapter presents the elements of a psychiatric assessment. After hearing the patient’s chief complaint, the physician elicits the patient’s history of the present illness (a chronological, systematic description of the patient’s signs and symptoms) past psychiatric history, medical history, psychosocial history, family history, and review of systems. The physician also obtains the patient’s mental status examination, which is an objective description of his or her current mental state. Integration of the patient’s history and objective findings results in a comprehensive descriptive and diagnostic impression, which summarizes patterns of data, predicts prognosis, and suggests appropriate treatment options. Use of a biopsychosocial and cultural perspective produces a psychiatric assessment that considers the patient’s strengths and vulnerabilities in relation to his or her cultural group.

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