International journal of psychiatry in medicine
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Int J Psychiatry Med · Jan 2014
Ramelteon for the treatment of delirium in elderly patients: a consecutive case series study.
Melatonin is effective in the prevention and treatment of delirium. Ramelteon has few adverse effects and higher affinity for MT1 and MT2 receptors than melatonin. The aim of the present study was to determine the efficacy of ramelteon in elderly patients with delirium caused by different primary diseases/conditions. ⋯ Our study suggested that ramelteon was a safe and useful alternative to melatonin for the treatment of delirium in elderly patients. Randomized, controlled studies are necessary to confirm the therapeutic benefits of ramelteon.
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Int J Psychiatry Med · Jan 2014
Realizing Engel's biopsychosocial vision: resilience, compassion, and quality of care.
George Engel's biopsychosocial vision was simultaneously scientific and humanistic. He passionately presented an approach to clinical care to correct the progressive distancing of clinical care and research from the lived experience of the patient. Yet, while science provides ever greater evidence for the linkages between subjectively-reported experience and health outcomes, trainees and practicing clinicians struggle to realize a biopsychosocial vision in a pragmatic way. ⋯ Importantly, trainees and clinicians get stuck implementing the biopsychosocial model partly because they have not developed the capacity for resilience, self-awareness, and self-monitoring. These capacities must accompany efforts to help clinicians engage more deeply with their patients; otherwise, they risk emotional distress, empathic failure, premature closure, and withdrawal from effective connections with patients. This article will explore ways in which Engel's biopsychosocial vision can be realized through building the capacities of clinicians to become more self-aware and resilient, and engage in compassionate action.
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Int J Psychiatry Med · Jan 2013
Review Case ReportsSuicide prevention as a prerequisite for recovery from severe mental illness.
For a significant number of people suffering from severe mental illness (SMI) prevention of suicide is a prerequisite for their recovery. This review summarises and interprets risk/protective factors for suicide in the context of schizophrenia and bipolar disorder, thereby enabling evidence-based suicide risk assessment and management. A history of self-harm greatly increases suicide risk among people with schizophrenia or bipolar disorder. ⋯ Research suggests that suicide risk associated with SMI should be reduced by early intervention, restricting access to lethal means, improvement of treatment adherence, treating more patients with clozapine and lithium, assertive outreach, treating psychiatric comorbidity (depression, alcohol/drug misuse, etc.), 24-hour crisis care, timely (compulsory) hospitalization (sufficient bed provision imperative), improving psychiatric inpatient ward safety, lowering the risk of absconding from wards, appropriate use of electroconvulsive therapy, intensive follow-up postdischarge, and improving access to psychological/psychosocial interventions, notably cognitive behavioural therapy. The clinical interview is the optimum method of suicide risk assessment and locally developed risk assessment tools should not be used. Evidence-based suicide risk assessment/management within primary care and secondary mental health services warrants recurrent, mandatory training.
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Int J Psychiatry Med · Jan 2013
Randomized Controlled Trial Multicenter StudyAssociation of anxiety and depression with pulmonary-specific symptoms in chronic obstructive pulmonary disease.
To examine the association of anxiety and depression with pulmonary-specific symptoms of Chronic Obstructive Pulmonary Disease (COPD), and to determine the extent to which disease severity and functional capacity modify this association. ⋯ Anxiety and depression were associated with higher levels of fatigue, shortness of breath, and frequency of COPD symptoms. It is important for clinicians to be aware of the presence of anxiety and depression in COPD patients, which appears to correlate with pulmonary-specific COPD symptoms, especially in patients with lower functional capacity. Prospective design studies are needed to elucidate the causal relationships between anxiety and depression and pulmonary-specific symptoms in COPD patients.
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Int J Psychiatry Med · Jan 2013
Comparative StudyComparison of consecutive periods of 1-, 2-, and 3-year mortality of geriatric inpatients with delirium, dementia, and depression in a consultation-liaison service.
Dementia, depression, and delirium are the most prevalent psychiatric disorders in elderly medical inpatients and are all associated with higher mortality. The purpose of this study was to assess and compare consecutive periods of 1-, 2-, and 3-year mortality among elderly patients with dementia, depression, and delirium seen by a psychiatry consultation-liaison service in a general hospital. ⋯ Clinical physicians should give special attention to delirious patients within the first year after referral. Patients at risk for mortality should be closely followed and early intervention provided in an effort to decrease or delay mortality.