scholarly journals The use of ‘drug dogs' in psychiatry

2004 ◽  
Vol 28 (6) ◽  
pp. 196-198 ◽  
Author(s):  
Harvey Gordon ◽  
Daniel Haider
Keyword(s):  
Substance Misuse ◽  
Psychiatric Treatment ◽  
Treatment Resistance ◽  
Antisocial Behaviour ◽  
Child And Adolescent Psychiatry ◽  
Mental Illnesses ◽  
Financial Cost ◽  
General Psychiatry ◽  
Old Age Psychiatry ◽  
Effective Use

Comorbidity of severe mental illness and substance misuse is now common in general psychiatry (Regier et al, 1990), and perhaps almost standard in forensic psychiatry (Snowden, 2001). It is also reflected in child and adolescent psychiatry (Boys et al, 2003) and even in old age psychiatry (Jolley et al, 2004). The range of hazards associated with substance misuse in people with mental illnesses includes elevated risk of relapse of psychosis (Cantwell & Harrison, 1996), increased frequency of hospitalisation (Bartels et al, 1993), poorer compliance with treatment (Jablensky et al, 1992), higher levels of treatment-resistance (Bowers et al, 1990), impairment of the integrity of therapeutic regimes in hospital settings and in hostels in the community (Sandford, 1995), stress in the community (Drake & Wallach, 1989), higher rates of homelessness (Scheller-Gilkey et al, 1999), increased suicidality (Drake & Wallach, 1989), and increased potential for antisocial behaviour and crime of both an acquisitive and a violent nature (Stewart et al, 2000; Sinha & Easton, 1999). The misuse of substances is therefore a significant obstruction to the effective use of psychiatric treatment, and the financial cost associated with such clinical adversity must run into millions of pounds.

scholarly journals Additional clinical experience (ACE) modules in psychiatric specialities for general practice registrars

2001 ◽  
Vol 25 (11) ◽  
pp. 449-451 ◽  
Author(s):  
Andrew F. Tarbuck ◽  
Daphne Rumball ◽  
Stephen M. Jones
Keyword(s):  
General Practice ◽  
Psychiatric Comorbidity ◽  
Substance Misuse ◽  
Child And Adolescent Psychiatry ◽  
House Officer ◽  
Junior Doctors ◽  
Senior House Officer ◽  
Adult Psychiatry ◽  
Old Age Psychiatry ◽  
Primary Substance

As part of training for general practice, approximately 40% of junior doctors will undertake a senior house officer (SHO) post in psychiatry (Ratcliffe et al, 1999). The majority of such posts will be within general adult psychiatry. As a result of this general practitioner (GP) trainees often receive little exposure to old age psychiatry or child and adolescent psychiatry. Similarly, although trainees will inevitably gain some experience of substance misuse associated with mental illness, there is little opportunity to develop skills in addressing primary substance misuse disorders and there is a clear need to develop better skills in the recognition and management of psychiatric comorbidity (Commander et al, 1999).

Do community mental health teams caring for severely mentally ill patients adjust treatments and services based on patients’ antisocial or criminal behaviours?

2009 ◽  
Vol 24 (6) ◽  
pp. 373-379 ◽  
Author(s):  
S. Hodgins ◽  
A. Cree ◽  
F. Khalid ◽  
K. Patel ◽  
R. Sainz-Fuentes ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mentally Ill ◽  
Aggressive Behaviour ◽  
Service Use ◽  
Substance Misuse ◽  
Illicit Drug ◽  
Antisocial Behaviour ◽  
Positive Symptoms ◽  
Severely Mentally Ill

AbstractBackgroundAntisocial behaviour is common among patients with severe mental illness (SMI) requiring hospitalisation.AimTo determine whether differential treatments and services are provided to patients with SMI who engage in antisocial behaviour.MethodA random sample of 161 inpatients with SMI were recruited from general adult wards and assessed at baseline and two years later. Information on symptoms, aggressive behaviour, substance misuse, and service use was obtained from patients and clinical files.ResultsPast antisocial behaviours were not associated with type or intensity of treatments and services. Severity of positive symptoms, aggressive behaviour, and illicit drug use were positively associated with the frequency of CMHT contact, but not with the type of CMHT, type of medication, or other treatments and benefits.ConclusionsWhile the frequency of meetings with CMHTs increased with the severity of antisocial behaviours, no specific treatments were provided to patients with SMI engaging in antisocial behaviours.

scholarly journals Advances in psychiatric treatment in primary care

2001 ◽  
Vol 7 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Christopher Dowrick
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
National Health Service ◽  
Health Service ◽  
Health Professionals ◽  
Depressive Disorders ◽  
Mental Health Problems ◽  
Psychiatric Treatment ◽  
Mental Illnesses ◽  
Breaking Work

Following ground-breaking work by Shepherd et al (1966) and, more recently, Goldberg & Huxley (1992), primary care is now recognised as the arena in which most contact occurs between the National Health Service (NHS) and people with mental health problems. General practitioners (GPs) remain the first, and in many cases the only, health professionals involved in the management of a whole range of conditions, from common anxiety and depressive disorders to severe and enduring mental illnesses.

scholarly journals First Do No Harm: An Analysis of the Risk Aspects and Side Effects of Clinical Holistic Medicine Compared With Standard Psychiatric Biomedical Treatment

2007 ◽  
Vol 7 ◽  
pp. 1810-1820 ◽  
Author(s):  
Søren Ventegodt ◽  
Isack Kandel ◽  
Joav Merrick
Keyword(s):  
Side Effects ◽  
Psychiatric Treatment ◽  
Treatment Method ◽  
Mental Illnesses ◽  
Holistic Medicine ◽  
Treatment As Usual ◽  
Philosophy Of Life ◽  
Do No Harm ◽  
Comparative Review ◽  
Patients At Risk

Clinical holistic medicine (CHM) is short-term psychodynamic psychotherapy (STPP) complemented with bodywork and philosophical exercises, to be more efficient in treating patients with severe mental and physical illness. STPP has already been found superior to psychiatric treatment as usual (TAU) and thus able to compete with psychiatric standard treatment as the treatment of choice for all non-organic mental illnesses; we have found the addition of bodywork and philosophy of life to STPP to accelerate the process of existential healing and recovery (salutogenesis). In this paper we compare the side effects, suicidal risk, problems from implanted memory and implanted philosophy of CHM with psychopharmacological treatment. Method: Qualitative and quantitative comparative review. Results: In all aspects of risks, harmfulness, and side effects, we have been considering, CHM was superior to the standard psychiatric treatment. The old principle of “first do no harm“ is well respected by CHM, but not always by standard psychiatry. CHM seems to be able to heal the patient, while psychopharmacological drugs can turn the patient into a chronic, mentally ill patient for life. Based on the available data CHM seems another alternative to patients with mental illness. There seem to be no documentation at all for CHM being dangerous, harmful, having side effects of putting patients at risk for suicide. As CHM uses spontaneous regression there is no danger for the patient developing psychosis as, according to some experts, has been seen with earlier intensive psychodynamic methods. CHM is an efficient, safe and affordable cure for a broad range of mental illnesses.

Psychopharmacology in Psychiatric Emergencies

1981 ◽  
Vol 10 (3) ◽  
pp. 189-204 ◽  
Author(s):  
Irl Extein
Keyword(s):  
Psychiatric Treatment ◽  
Emergency Setting ◽  
Antipsychotic Medications ◽  
Psychiatric Emergencies ◽  
Medical Disorders ◽  
Steady State Kinetics ◽  
Sedative Hypnotics ◽  
Time Required ◽  
Effective Use ◽  
Severe Anxiety

Pharmacotherapy is crucial to the emergency psychiatric treatment of patients who are out of control in a variety of psychiatric and medical disorders. The time required for the more definitive pharmacological treatment of the major psychiatric syndromes is such that they can at best be only started in the emergency setting. The emergency treatment of patients who are severely agitated, violent, or psychotic is based on the IM administration of antipsychotic medications, such as haloperidol. In conjunction with psychological support this can provide effective, safe, and humane treatment. Sedative-hypnotics, such as diazepam, can be helpful for less severe anxiety states. This article focused on clinical and pharmacokinetic principles of the use of these medications, the understanding of which can help maximize their effective use in emergencies. Topics which are emphasized include sedative, antipsychotic and disinhibiting effects, side effects, absorption after oral and IM administration, and the concepts of steady-state kinetics and the “loading dose.”

scholarly journals MON-252 Pituitary Tumor Apoplexy Presenting with Acute Psychosis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Maria Mercedes Pineyro ◽  
Patrica Agüero ◽  
Florencia Irazusta ◽  
Claudia Brun ◽  
Paula Duarte ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Pituitary Tumor ◽  
Psychiatric Treatment ◽  
Psychiatric Symptoms ◽  
Mental Illnesses ◽  
Psychotic Symptoms ◽  
Acute Psychosis ◽  
Sellar Mass ◽  
History Of ◽  
Pituitary Tumor Apoplexy

Abstract Background: Pituitary tumors (PT) can present with neuropsychiatric symptoms. It has been associated with hormonal changes, as well as extension of the tumor to the diencephalon. Psychopathology has been reported in up to 83% in Cushing Disease (CD) and 35% in acromegaly (ACR). Psychiatric disorders (depression, anxiety and psychosis) have been reported up to 77% in CD and 63% in ACR. We present a rare case of a patient presenting with acute psychosis and a PT apoplexy. Case: A 27 year-old Caucasian female with a PMH of primary hypothyroidism presented with a 15-day history of delusions. She had delusional ideas on the subject of harm and prejudice, persecutory and mystical-religious. The mechanism was mainly intuitive and interpretive with false acknowledgments. She also had sleep disturbance, death ideation and subacute alteration of consciousness. There was no history of substance abuse or psychiatric disorders. She did not report headaches, visual disturbances, symptoms of hormone hypersecretion or hypopituitarism. She had regular menses on BCP. She had no family history of mental illnesses. Physical exam revealed reluctance, latency in responses and bradypsychia. She did not have acromegalic or cushingoid features. She was diagnosed with acute psychosis with atypical features so a brain CT was performed, which showed a sellar mass. Pituitary MRI revealed a sellar mass measuring 15x12x13 mm, with suprasellar extension, optic chiasm compression, hyperintense on T1- and hypointense on T2-weighted imaging compatible with subacute hemorrhage. She was treated with neuroleptics and benzodiazepines. Lab work revealed high prolactin (PRL) (114ng/dl), and normal 8 AM cortisol, FT4, LH, FSH and IGF-1 levels. Repeated PRL was 31,6 ng/dl after changing psychiatric treatment to aripiprazole. Her psychiatric symptoms improved. We postulate a diagnosis of PT apoplexy that presented with acute psychosis. In relation to the nature of the PT we postulate a non functioning pituitary adenoma (NFA) or a partial resolution of a prolactinoma after apoplexy. A follow up MRI is pending. Discussion: Infrequently, psychiatric symptoms may be the primary manifestation of brain tumors. Patients with PT have been reported to have altered quality of life, reduced coping strategies, increased prevalence of psychopathological alterations and maladaptive personality disorders. In addition, they can present with psychotic symptoms, mostly reported with hormone excess (GH and cortisol). Psychiatric symptoms such as anxiety and neurosis have been reported in NFA and prolactinomas. However, it is not clear a higher prevalence of psychiatric illnesses in these tumors. To our knowledge this is the first case of a pituitary tumor apoplexy presenting with acute psychosis. Conclusion: Psychiatric symptoms can be the first manifestation of PT, so atypical presentations should warrant further workup with brain imaging.

Neurobiological mechanisms of repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex in depression: a systematic review

2015 ◽  
Vol 45 (16) ◽  
pp. 3411-3432 ◽  
Author(s):  
Y. Noda ◽  
W. K. Silverstein ◽  
M. S. Barr ◽  
F. Vila-Rodriguez ◽  
J. Downar ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Treatment Resistance ◽  
Mental Illnesses ◽  
Antidepressant Effect ◽  
Therapeutic Effects ◽  
Dependent Manner ◽  
Exclusion Criteria ◽  
Promising Alternative

Depression is one of the most prevalent mental illnesses worldwide and a leading cause of disability, especially in the setting of treatment resistance. In recent years, repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising alternative strategy for treatment-resistant depression and its clinical efficacy has been investigated intensively across the world. However, the underlying neurobiological mechanisms of the antidepressant effect of rTMS are still not fully understood. This review aims to systematically synthesize the literature on the neurobiological mechanisms of treatment response to rTMS in patients with depression. Medline (1996–2014), Embase (1980–2014) and PsycINFO (1806–2014) were searched under set terms. Three authors reviewed each article and came to consensus on the inclusion and exclusion criteria. All eligible studies were reviewed, duplicates were removed, and data were extracted individually. Of 1647 articles identified, 66 studies met both inclusion and exclusion criteria. rTMS affects various biological factors that can be measured by current biological techniques. Although a number of studies have explored the neurobiological mechanisms of rTMS, a large variety of rTMS protocols and parameters limits the ability to synthesize these findings into a coherent understanding. However, a convergence of findings suggest that rTMS exerts its therapeutic effects by altering levels of various neurochemicals, electrophysiology as well as blood flow and activity in the brain in a frequency-dependent manner. More research is needed to delineate the neurobiological mechanisms of the antidepressant effect of rTMS. The incorporation of biological assessments into future rTMS clinical trials will help in this regard.

Editorial to Child and Adolescence Psychopharmacology

2016 ◽  
Vol 49 (06) ◽  
pp. 217-218
Author(s):  
G. Juckel
Keyword(s):  
Young Patients ◽  
Child And Adolescent ◽  
Child And Adolescent Psychiatry ◽  
Mental Illnesses ◽  
Educational Strategies ◽  
Behavioral Disturbances ◽  
Treatment Regimens ◽  
Psychopharmacological Treatment ◽  
Wide Range ◽  
Meta Analyses

The editors of Pharmacopsychiatry have decided in 2016 to prepare special issues regularly in order provide our readers volumes of the journal with a thematic focus 1. The first such special issue is dedicated to the field of child and adolescent psychopharmacology. Many young patients are treated with psychotherapeutic, but also pharmacotherapeutic, methods worldwide. Most of our psychopharmacological agents are not approved by the federal institutions for persons under 18 years old. However, severe mental illnesses like schizophrenia, depression, anxiety, ADHD, and bipolar disorder frequently require pharmacological treatments in children and adolescents. We also see a wide range of rather unspecific emotional and behavioral disturbances up to excitation crises or suicidal acts in this young population, so that we see the necessity for standardized and valid psychopharmacological treatment regimens based on meta-analyses, randomized controlled trials, and guidelines 2. Child and adolescent psychiatry is unfortunately far away from this; industry-supported research is rare in this area, but also not all child and adolescent psychiatrists see the importance of psychopharmacological treatment and trust specific psychotherapy, psychoeducation, and educational strategies. These are all extremely important treatments, but one can/should think that psychopharmacotherapy is an important addition and often a cornerstone for the other treatments.

Treatment Response and Resistance in Schizophrenia

2018 ◽  
Keyword(s):  
Real World ◽  
Psychotic Disorders ◽  
Treatment Strategies ◽  
Treatment Resistance ◽  
Mental Illnesses ◽  
New Drugs ◽  
Behaviour Therapy ◽  
Clozapine Treatment ◽  
Clinical Scenarios ◽  
Cognitive Behaviour

Schizophrenia and other psychotic disorders are common mental illnesses, but their treatment is complex. This book provides a state-of-the-art overview of their treatment, with a focus on the real-world challenges faced by clinicians and patients. It brings together contributions from leading experts from around the world to cover key conceptual issues, including how to evaluate response, the nature of treatment resistance, ultra-medication (clozapine) treatment resistance, and pseudo-resistance, and how to choose a first-line antipsychotic drug that maximizes response and minimizes side effects. It also covers how to use clozapine, and alternatives to it, the use of family interventions and cognitive behaviour therapy for psychosis, and treatment strategies where clozapine has not worked, as well as new drugs and non-pharmacological treatments in the pipeline. All contributions are based on the latest evidence, focusing on systematic reviews and meta-analyses, where available, but are informed throughout by the authors’ clinical experience. This is brought together in a section where the evidence is applied to real-world clinical scenarios from the authors’ own practice. Overall, readers will gain a thorough understanding of the clinical challenges, the latest evidence in the field, and how to apply it to give patients the best chance of getting better.

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