Abstract: According to the Hunter Serotonin Toxicity Criteria, the presence of either clonus or hyperreflexia is a must for making a diagnosis of Serotonin syndrome (SS). We report five patients with SS who had areflexia because of associated polyneuropathy. None of the patients fulfilled the Hunter criteria for SS.

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Abstract: Skilled clinical decision making in the diagnosis and treatment of chronic pain can create unique clinical and ethical challenges, particularly when opioid medications are involved. This report presents the case of a pregnant woman who sought treatment for an illicit opioid dependence, initiated by opioid analgesic treatment of chronic pain. While recognizing opioids’ high level of effectiveness for pain relief, the case demonstrates the potential harms of opioid medications for particular patients

Source: General Hospital Psychiatry


Bupropion: 5 tips

By Flavio Guzman, MD
Editor, Psychopharmacology Institute

 

In this psychopharmacology refresher series, from the Psychopharmacology Institute, we discuss key aspects of commonly used medications. Today we start with 5 important concepts about bupropion.

1. Non-serotonergic. It does not influence serotonergic neurotransmission: it is a norepinephrine dopamine reuptake inhibitor without activity on the serotonin reuptake transporter.

 

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Importance The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multicomponent study designed to generate actionable recommendations to reduce Army suicides and increase knowledge of risk and resilience factors for suicidality. Objectives To present data on prevalence, trends, and basic sociodemographic and Army experience correlates of suicides and accident deaths among active duty Regular Army soldiers between January 1, 2004, and December 31, 2009, and thereby establish a foundation for future Army STARRS investigations.

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Importance Young adults have high levels of behavioral health needs but often lack health insurance. Recent health reforms have increased coverage, but it is unclear how use of hospital-based care changed after expanding insurance. Objective To evaluate the association between health insurance coverage expansions and use of hospital-based care among young adults with behavioral health diagnoses.

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One of the upsides of so many snowstorms this winter has been the chance to catch up on reading. I’ve been enjoying Erik Brynjolfsson and Andrew McAfee’s book the Second Machine Age about the social revolution instigated by the digital revolution.

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Importance No highly effective interventions to prevent delirium have been identified. Objective To examine whether ramelteon, a melatonin agonist, is effective for the prevention of delirium. Design, Setting, and Participants A multicenter, rater-blinded, randomized placebo-controlled trial was performed in intensive care units and regular acute wards of 4 university hospitals and 1 general hospital

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Delirium is a common neuropsychiatric syndrome, especially in patients with preexistent cognitive impairment. Delirium is often precipitated by an acute infection, an operation, or an intensive care unit (ICU) stay and is associated with premorbid conditions, such as cerebral infarction, dementia, and genetic predisposition. The syndrome manifests itself in up to 50% of elderly hospitalized inpatients, with higher frequencies reported for ICU patients.

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Abstract: Objective: The number of psychiatric hospital beds in England has declined since the 1950s. Since the early 2000s mental health staff increasingly work in community treatment teams.We analysed recent trends in hospital and community treatment in England for eight mental health diagnoses.Method: We obtained data from the UK Government Health and Social Care Information Centre covering the period 1998 to 2012.

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Abstract: Purpose: Exploring three perspectives on differences between general practitioners (GP) and psychiatrists in clinical decision making about depressed patients. The gold standard perspective focuses on differences in decisions (output) as a result of lack of expertise, the input perspective relates differences to different information use and to other roles, and the throughput perspective attributes differences to other information processing.Methods: 26 psychiatrists and 25 general practitioners (GPs) gave their clinical judgment on four on-line vignettes of increasingly severely depressed patients. Supplementary information on 15 themes could be asked for by clicking on underlined phrases.

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