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.”

Learning to Control the Program Evolution Process with Cultural Algorithms

1997 ◽  
Vol 5 (2) ◽  
pp. 181-211 ◽  
Author(s):  
Elena Zannoni ◽  
Robert G. Reynolds
Keyword(s):  
Genetic Programming ◽  
Population Level ◽  
Extraction Process ◽  
Cultural Algorithms ◽  
Genetic Operators ◽  
Regression Problem ◽  
Standard Procedures ◽  
Programming Process ◽  
Time Required ◽  
Effective Use

Traditional software engineering dictates the use of modular and structured programming and top-down stepwise refinement techniques that reduce the amount of variability arising in the development process by establishing standard procedures to be followed while writing software. This focusing leads to reduced variability in the resulting products, due to the use of standardized constructs. Genetic programming (GP) performs heuristic search in the space of programs. Programs produced through the GP paradigm emerge as the result of simulated evolution and are built through a bottom-up process, incrementally augmenting their functionality until a satisfactory level of performance is reached. Can we automatically extract knowledge from the GP programming process that can be useful to focus the search and reduce product variability, thus leading to a more effective use of the available resources? An answer to this question is investigated with the aid of cultural algorithms. A new system, cultural algorithms with genetic programming (CAGP), is presented. The system has two levels. The first is the pool of genetic programs (population level), and the second is a knowledge repository (belief set) that is built during the GP run and is used to guide the search process. The microevolution within the population brings about potentially meaningful characteristics of the programs for the achievement of the given task, such as properties exhibited by the best performers in the population. CAGP extracts these features and represents them as the set of the current beliefs. Beliefs correspond to constraints that all the genetic operators and programs must follow. Interaction between the two levels occurs in one direction through the extraction process and, in the other, through the modulation of an individual's program parameters according to which, and how many, of the constraints it follows. CAGP is applied to solve an instance of the symbolic regression problem, in which a function of one variable needs to be discovered. The results of the experiments show an overall improvement on the average performance of CAGP over GP alone and a significant reduction of the complexity of the produced solution. Moreover, the execution time required by CAGP is comparable with the time required by GP alone.

Teaching Tip: Designing Flipped Classrooms to Enhance Learning in the Clinical Skills Laboratory

2021 ◽  
pp. e20210043
Author(s):  
Sarah Baillie ◽  
Annelies Decloedt ◽  
Molly Frendo Londgren
Keyword(s):  
Student Engagement ◽  
Flipped Classroom ◽  
Clinical Skills ◽  
Face To Face ◽  
Use Of Time ◽  
Skills Laboratory ◽  
The Face ◽  
Expected Benefits ◽  
Time Required ◽  
Effective Use

Flipped classroom is an educational technique in which content is delivered online for students to study at their own pace in preparation for in-class learning. Benefits include increased flexibility, enhanced student engagement and satisfaction, and more effective use of time spent during face-to-face teaching. However, the development and implementation of flipped classroom teaching are also associated with challenges, including time required to develop learning materials and getting students to engage with the preparatory work. This teaching tip describes a structured approach to designing and implementing the flipped classroom approach for clinical skills to allow a greater focus on practicing the hands-on skills and the provision of feedback during the laboratory session. First, the rationale for flipping the classroom and the expected benefits should be considered. On a practical level, decisions need to be made about what to include in the flipped component, how it will complement the face-to-face class, and how the resources will be created. In the design phase, adopting a structured template and aligning with established pedagogical principles is helpful. A well-designed flipped classroom motivates learners by including different elements such as quality educational media (e.g., videos), the opportunity to self-assess, and well-defined connections to relevant knowledge and skills. Student engagement with the flipped material can be promoted through different strategies such as clear communication to manage student expectations and adapting the delivery of the face-to-face component. Finally, gathering feedback and evaluating the initiative are important to inform future improvements.

scholarly journals LevioSAM: Fast lift-over of alternate reference alignments

2021 ◽  
Author(s):  
Taher Mun ◽  
Nae-Chyun Chen ◽  
Ben Langmead
Keyword(s):  
Population Genetics ◽  
Coordinate System ◽  
Data Structures ◽  
Succinct Data Structures ◽  
Reference Coordinate System ◽  
Link Type ◽  
A Chain ◽  
Time Required ◽  
Effective Use

AbstractMotivationAs more population genetics datasets and population-specific references become available, the task of translating (“lifting”) read alignments from one reference coordinate system to another is becoming more common. Existing tools generally require a chain file, whereas VCF files are the more common way to represent variation. Existing tools also do not make effective use of threads, creating a post-alignment bottleneck.ResultsLevioSAM is a tool for lifting SAM/BAM alignments from one reference to another using a VCF file containing population variants. LevioSAM uses succinct data structures and scales efficiently to many threads. When run downstream of a read aligner, levioSAM completes in less than 13% the time required by an aligner when both are run with 16 threads.Availabilityhttps://github.com/alshai/[email protected], [email protected]

Evaluation of Concentration Techniques For Small Populations of Gunshot Residue (GSR) Particles Using Calibrated GSR Suspensions

1985 ◽  
Vol 43 ◽  
pp. 130-131 ◽  
Author(s):  
A. Zeichner ◽  
H. A. Foner ◽  
M. Dvorachek
Keyword(s):  
Small Area ◽  
Gunshot Residue ◽  
Small Populations ◽  
X Ray ◽  
Comprehensive Search ◽  
Size And Morphology ◽  
Time Required ◽  
Effective Use ◽  
Scanning Electron ◽  
Made In

It is generally accepted that the best method for the identification of GSR is by scanning electron microscopy with energy dispersive x-ray analysis (SEM-EDX), a technique which utilizes not only the chemical composition of the particles but also their size and morphology. Nevertheless, there remain many problems in the effective use of this technique.The main problem is the length of time required to conduct a comprehensive search for GSR in the samples as presented to the SEM. Attempts to solve this problem have been made in two main directions: (1) Concentration of the GSR after sampling onto a small area concomittant with some sort of treatment to remove extraneous interfering matter, and (2) computer-aided mechanization of the searching procedure. The latter approach is still in its very early experimental stages, whilst the methods used in the second approach are in need of further improvement. In particular, there has been no quantitative work on the efficiency of various concentration processes when using very small populations of GSR.

scholarly journals Unusual presentation of pheochromocytoma: thirteen years of anxiety requiring psychiatric treatment

2018 ◽  
Vol 2018 ◽  
Author(s):  
Catherine Alguire ◽  
Jessica Chbat ◽  
Isabelle Forest ◽  
Ariane Godbout ◽  
Isabelle Bourdeau
Keyword(s):  
Panic Disorder ◽  
Psychiatric Treatment ◽  
Hepatic Metastases ◽  
Panic Attacks ◽  
Benign Tumors ◽  
Common Symptom ◽  
List Type ◽  
Presenting Symptoms ◽  
Severe Anxiety

Summary Pheochromocytoma is a rare tumor of the adrenal gland. It often presents with the classic triad of headache, palpitations and generalized sweating. Although not described as a typical symptom of pheochromocytoma, anxiety is the fourth most common symptom reported by patients suffering of pheochromocytoma. We report the case of a 64 year old man who had severe anxiety and panic disorder as presenting symptoms of pheochromocytoma. After 13 years of psychiatric follow-up, the patient was diagnosed with malignant pheochromocytoma. After surgical resection of his pheochromocytoma and his hepatic metastases, the major panic attacks completely disappeared, the anxiety symptoms improved significantly and the psychiatric medications were stopped except for a very low maintenance dose of venlafaxine. We found in our cohort of 160 patients with pheochromocytoma 2 others cases of apparently benign tumors with severe anxiety that resolved after pheochromocytoma resection. These cases highlight that pheochromocytoma should be included in the differential diagnosis of refractory anxiety disorder. Learning points: Anxiety and panic disorder may be the main presenting symptoms of pheochromocytoma. The diagnosis of pheochromocytoma should be excluded in cases of long-term panic disorder refractory to medications since the anxiety may be secondary to a catecholamine-secreting tumor. Surgical treatment of pheochromocytoma leads to significant improvement of anxiety disorders.

Discussing First Aid Training Issues of Psychiatric Emergencies

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
C. Tsopelas ◽  
F. Kapsali ◽  
S. Tsetsou ◽  
K. Kardaras ◽  
D. Oikonomou ◽  
...  
Keyword(s):  
Web Search ◽  
Treatment Guidelines ◽  
Psychiatric Treatment ◽  
Diagnostic Procedures ◽  
Psychiatric Emergencies ◽  
Medical Databases ◽  
Diagnosis By Exclusion ◽  
First Aid Training ◽  
Usual Clinical Practice ◽  
Medical Emergencies

Aims:Psychiatry is considered a specialty not having a lot to do with medical emergencies. Psychiatrists are being asked to contribute to medical treatment or diagnosis after the completion of diagnostic procedures by physicians, often concluded in a diagnosis by exclusion. Having said that, emergency psychiatric issues often arise in usual clinical practice.Methods:Thorough research of the main medical databases, and web search engines for relevant studies. We scrutinize them independently, before reaching consensus about appropriateness.Results:There are several books, articles and guidelines that go beyond the psychiatric emergencies of mentally ill patients, aiming to provide guidelines for the providers of emergency treatment in settings that access to psychiatric treatment is limited due to obstacle of time or distance.Conclusions:Although general in concept and not particularly concerned with the accuracy of psychiatric diagnosis and the description of symptoms and signs of psychopathology, there are general guidelines well described that a qualified nurse, social worker or an ambulance worker could apply. We have an obligation to disseminate knowledge about dealing with psychiatric emergencies especially to health services at remote areas. Publication of treatment guidelines that are easy to apply, could be the next step in recognition, early intervention and appropriate referral in challenging psychiatric situations at the members states of European Union.

scholarly journals Severe Anxiety Post-COVID-19 Infection

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Maggie Driscoll ◽  
Jason Gu
Keyword(s):  
Psychiatric Treatment ◽  
Neuropsychiatric Symptoms ◽  
Large Body ◽  
Intrusive Thoughts ◽  
Review Of The Literature ◽  
Timely Manner ◽  
Increased Risk ◽  
Self Harm ◽  
Severe Anxiety

COVID-19 infection is linked to increased risk of neuropsychiatric symptoms such as psychosis and suicidal ideation/behavior. After further review of the literature, there is not a large body of data on anxiety following COVID-19 infection. Most literature found is related to fear/anxiety of contracting and dying from COVID-19. We illustrate a case of a 27-year-old male with no previous psychiatric treatment history or symptomology, who developed severe anxiety with intrusive thoughts of self-harm via firearm after COVID-19 infection. Given the severe nature of the anxiety and intrusive thoughts, the patient feared for his safety and sought acute inpatient admission. The patient was effectively treated with group therapy and psychotropic medications and was able to be discharged in a timely manner with outpatient psychiatric follow-up. Much is still unknown of COVID-19. With this case report, we discuss a potential relationship between anxiety and COVID-19 infection.

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.

A Cost-Effective Performance Development of the PT6A-65 Turboprop Compressor

1985 ◽  
Author(s):  
Tsukasa Yoshinaka ◽  
Kenneth S. Thue
Keyword(s):  
Flow Analysis ◽  
Axial Compressor ◽  
Cost Effective ◽  
Detailed Examination ◽  
Centrifugal Stage ◽  
Engine Family ◽  
Effective Performance ◽  
Performance Development ◽  
Time Required ◽  
Effective Use

The largest member of the PT6 turboprop engine family, the PT6A-65, was developed in the early 1980’s and went into production in September 1982. The compressor for this engine consisted of four new axial stages combined with an existing centrifugal stage on a single shaft. This paper gives a brief description of the studies leading up to the choice of the compressor configuration and a more detailed examination of the development of the chosen compressor to the required performance level. The development of this compressor presented a two-fold technical challenge. Firstly, the limited space in the small compressor gas path did not permit the effective use of conventional total pressure and temperature probes for performance evaluation. Secondly, the short time available for development excluded some attractive corrective measures such as the redesign of some of the axial blade rows because the time required would have jeopardized the meeting of the tight development deadline. The first problem was overcome by a combination of limited wall static pressure measurements and an extensive use of numberical flow analysis codes. This approach proved to be quite cost-effective. The second was solved by the adaptation of an existing fully analytically-designed research axial stage to the first stage position in the axial compressor.

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