Spectrum Concept of Neuroleptic Malignant Syndrome

1988 ◽  
Vol 153 (1) ◽  
pp. 107-111 ◽  
Author(s):  
Adityanjec ◽  
Suarn Singh ◽  
Gurnam Singh ◽  
Susan Ong
Keyword(s):  
Clinical Practice ◽  
Neuroleptic Malignant Syndrome ◽  
Routine Clinical Practice ◽  
Clinical Implications ◽  
Clinical Presentations ◽  
Definition Of ◽  
Unitary Concept ◽  
Controversial Concept

Although neuroleptic malignant syndrome (NMS) was initially thought to be a rare, idiosyncratic complication, the incidence estimates have been rising over the years. A part of this increase can be explained on the basis of an over-inclusive definition of NMS. The unitary concept of NMS has been challenged recently and a spectrum concept has been enunciated on the basis of findings of retrospective chart-reviews which have used too broad a definition of NMS. The authors describe three cases of neuroleptic-related toxicity with different clinical presentations which appeared in a manner apparently supporting the spectrum concept. They discuss this controversial concept critically, however, and caution against its overzealous use in routine clinical practice owing to its far-reaching clinical implications.

The Assessment of Competence to Make a Treatment Decision: An Empirical Approach

1996 ◽  
Vol 41 (2) ◽  
pp. 85-92 ◽  
Author(s):  
Graham Bean ◽  
Shizuhiko Nishisato ◽  
Neil A Rector ◽  
Graham Glancy
Keyword(s):  
Clinical Practice ◽  
Health Professionals ◽  
Treatment Decision ◽  
Routine Clinical Practice ◽  
Individual Item ◽  
Interview Schedule ◽  
Assessment Of Competence ◽  
Item Scores ◽  
Definition Of ◽  
Attending Physician

Objective: To compare physicians' judgements of competency in routine clinical practice with the findings obtained from a structured clinical interview. Methods: Ninety-six patients referred for electroconvulsive therapy were administered the Competency Interview Schedule (CIS) prior to their first treatment. Cluster analysis was employed to categorize patients to 1 of 5 cluster centres represented by case studies previously judged competent or incompetent by lawyers and health professionals. Results: A match-mismatch table revealed 88% (N = 66) of the 75 patients found competent by the attending physician and 90.5% (N = 19) of the 21 patients found incompetent by the attending physician were classified in agreement with the CIS. The 9 misclassified patients found competent by the attending physician but classified incompetent by the CIS had consented to treatment. The 2 misclassified patients found incompetent by the attending physician but classified competent by the CIS had refused treatment. Examination of individual item scores from the CIS indicated that, in some cases, a different standard of competency was applied in routine clinical practice depending upon the patient's treatment decision. Conclusions: The CIS is presented as a useful guide for clinicians with an interest in competency evaluations but caution is advised in using the instrument to make formal evaluations of competency owing to the imprecise definition of competency in various jurisdictions.

scholarly journals Underdetection of comorbid drug use at acute psychiatric admission

2002 ◽  
Vol 26 (7) ◽  
pp. 248-251 ◽  
Author(s):  
A. Ley ◽  
D. Jeffery ◽  
J. Ruiz ◽  
S. McLaren ◽  
C. Gillespie
Keyword(s):  
Clinical Practice ◽  
Drug Use ◽  
Routine Clinical Practice ◽  
Clinical Implications ◽  
Patient Records ◽  
Psychiatric Admission

Aims and MethodThe ability of routine clinical practice to detect drug use at acute psychiatric admission was assessed by comparing the results of urinalysis with information on drug use extracted from patient records (n=112).ResultsUrinalysis detected drug use in 23% of the sample. Cannabis was the drug most frequently found. Of the cases of drug use positively identified by urinalysis, 54% were not identified in the notes. Some information on drug use proximal to admission was found in 40% of patient records. Patients asked about proximal drug use were younger than those not asked.Clinical ImplicationsAll patients should be asked about drug use.

scholarly journals Comparison of the effectiveness of depot antipsychotics in routine clinical practice

2010 ◽  
Vol 34 (7) ◽  
pp. 273-279 ◽  
Author(s):  
Polash Shajahan ◽  
Elizabeth Spence ◽  
Mark Taylor ◽  
Darlington Daniel ◽  
Anthony Pelosi
Keyword(s):  
Clinical Practice ◽  
Outcome Measures ◽  
Clinical Global Impression ◽  
Hazard Ratio ◽  
Routine Clinical Practice ◽  
Clinical Implications ◽  
Long Acting ◽  
Depot Antipsychotics

Aims and methodTo compare effectiveness of long-acting injections in schizophrenia and related psychoses in Lanarkshire, Scotland, from 2002 to 2008. We retrospectively assigned Clinical Global Impression (CGI) scores and examined discontinuation and hospitalisation rates.ResultsRisperidone, zuclopenthixol and flupentixol were associated with CGI improvement in 72-74% of individuals. Zuclopenthixol was associated with lower rates of discontinuation as a result of inefficacy compared with risperidone (hazard ratio (HR) = 0.11, 95% CI 0.05-0.27) and flupenthixol (HR = 0.14, 95% CI 0.05-0.39), and lower rates of hospitalisation compared with risperidone (HR = 0.32, 95% CI 0.17-0.56) and flupentixol (HR = 0.34, 95% CI 0.16-0.71). ‘Very much improved’ or ‘much improved’ on the CGI was seen in risperidone (29%), zuclopenthixol (16%) and flupentixol (37%), P<0.001.Clinical implicationsNo long-acting injection was clearly superior in all our outcome measures, supporting the continued need for a variety of long-acting depot antipsychotics to optimise the treatment of the range of patients seen in clinical practice.

Diagnosis and Management of Cardiomyopathies – A Focus on Genetics, Cardiac Magnetic Resonance and Clinical Features

2011 ◽  
Vol 7 (3) ◽  
pp. 225
Author(s):  
Gianfranco Sinagra ◽  
Michele Moretti ◽  
Giancarlo Vitrella ◽  
Marco Merlo ◽  
Rossana Bussani ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Imaging Techniques ◽  
Molecular Genetic ◽  
Molecular Genetic Analysis ◽  
Routine Clinical Practice ◽  
Clinical Approach ◽  
Diagnosis And Management ◽  
Made In

In recent years, outstanding progress has been made in the diagnosis and treatment of cardiomyopathies. Genetics is emerging as a primary point in the diagnosis and management of these diseases. However, molecular genetic analyses are not yet included in routine clinical practice, mainly because of their elevated costs and execution time. A patient-based and patient-oriented clinical approach, coupled with new imaging techniques such as cardiac magnetic resonance, can be of great help in selecting patients for molecular genetic analysis and is crucial for a better characterisation of these diseases. This article will specifically address clinical, magnetic resonance and genetic aspects of the diagnosis and management of cardiomyopathies.

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