The Psychiatric clinics of North America
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Suicidal behavior in older people is more often lethal than in any other age group. Social isolation, losses and physical illness, a past history of suicide attempts, and psychiatric illness are risk factors with implications for prevention of late life suicide. Preliminary indications are that community outreach to elders at risk and educational programs for primary care providers on the identification and treatment of late life depression are effective at lowering suicide rates.
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Psychiatr. Clin. North Am. · Jun 1997
ReviewPsychopharmacologic treatment of pathologic aggression.
Several drugs are apparently effective in treating pathologic anger and aggression. Because many of the studies on aggressive populations allowed the use of concomitant medications, it is unclear whether the efficacy of each drug in a particular population is dependent on the presence of other medications, such as antipsychotic agents. Finally, one needs to be circumspect in inferring efficacy of a particular drug in aggressive patients with neuropsychiatric conditions other than the ones in which some efficacy has been established. ⋯ Although widely used in the management of pathologic aggression, the use of this class of drugs has been limited partially by marked hypotension and bradycardia, which are side effects common at the higher doses. The usefulness of the antihypertensive drug clonidine in the treatment of pathologic aggression has not been assessed adequately, and only marginal benefits were observed with this drug in irritable autistic and conduct disorder children. Psychostimulants seem to be effective in reducing aggressiveness in brain-injured patients as well as in violent adolescents with oppositional or conduct disorders, particu
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Delirium is a state of disturbed consciousness and attention and cognition or perception, which develops acutely, fluctuates during the course of the day, and is attributable to a physical disorder. This syndrome is the focus of increasing attention in light of emerging evidence of its enormous impact in human suffering as well as patient care costs. As currently conceptualized, delirium is a threshold phenomenon in which systemic and cerebral insults are cumulative and, in most cases, are multifactorial in origin. ⋯ Benzodiazepine use is reserved for the specific treatment of alcohol and sedative withdrawal, and for adjunctive use with antipsychotic agents in treatment-refractory cases. There is growing evidence that the cognitive impairment of delirium is not entirely reversible in all patients, and it may be that delirium represents a time of significant risk for progression of underlying dementia. Preventive measures discussed in the text are, therefore, of particular importance in this population.
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The psychiatric literature on physician-assisted suicide is scant and almost universally opposed to legalization. This opposition stems from the traditional perspective of suicide as a symptom of mental illness and the tendency of psychiatrists to extend their view of suicide in the medically well to the terminally ill. This article examines the basis for and validity of this opposition and makes recommendations about the role of the psychiatrist in physician-assisted suicide.
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Psychiatr. Clin. North Am. · Sep 1996
ReviewDelirium. Advances in diagnosis, pathophysiology, and treatment.
This article discusses research in the areas of morbidity and mortality, epidemiologic risk factors, phenomenology, pathophysiology, and treatment of delirium. Delirium assessment instruments are reviewed. The neuropathophysiologic understanding of delirium is discussed in the context of important CNS neural circuitry. Pharmacologic treatments of delirium in adults and children are outlined, with particular emphasis on intravenous use of butyrophenone neuroleptics.