The Psychiatric clinics of North America
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Psychiatr. Clin. North Am. · Sep 1994
Historical ArticleA sketch of man's efforts to mend his troubled mind.
People have sought comfort for their miseries and a cure for their troubles since prehistoric times. View the highlights of the story of psychiatry in this lightning tour of psychiatric history.
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Psychiatr. Clin. North Am. · Jun 1994
ReviewPost-traumatic stress disorder in victims of disasters.
Disasters can produce significant, lasting psychological sequelae. Much of the disaster work that mental health professionals can do falls outside of the more traditional roles usually taken by mental health professionals. ⋯ To be most effective, we need to be involved in planning efforts that can be activated when disaster strikes, rather than being reactive to the situation after it has occurred. The potential range of responses can challenge the professional who wants to help his or her community when it has been affected.
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Psychiatr. Clin. North Am. · Dec 1993
Review Case ReportsDifferential diagnosis and psychopharmacology of dual disorders.
There are multiple potential interactions of substances of abuse with psychiatric illnesses. The individual agents, the stage of abuse, withdrawal, or recovery, and the patient's psychiatric illness must be considered as an integrated whole to ascertain the appropriate interventions. Polysubstance abuse can cause still more complicated interactions. ⋯ Greater efforts are needed to focus equal energy on diagnosis and treatment of chemical-dependency disorders in "psychiatric" populations. Many studies show that physicians neglect to collect adequate information and are not sufficiently aggressive in referring patients to chemical dependence treatment programs. By combining knowledge and appropriate therapeutic interventions from both psychiatric and addiction treatment fields, the needs of the dually diagnosed patient can be met more adequately.
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Clozapine is a great advance in the treatment of schizophrenia. It should be tried in any neuroleptic-resistant schizophrenic as well as some who are neuroleptic intolerant. If progress is made in controlling its agranulocytosis, clozapine could be the drug of choice for all types of schizophrenia and perhaps other conditions as well for which neuroleptic drugs are employed, e.g., mania resistant to mood stabilizers. ⋯ How much better tolerated it is than currently available drugs, especially thioridazine, is not clear. Many other novel agents are being tested. Clinicians will be challenged to follow this emerging field closely and identify the most promising new agents that may be indicated for specific stages of, or subtypes of, schizophrenia.
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Delirium is a common syndrome in hospitalized medical and surgical patients and in those seen in emergency departments. It is particularly common in the demented elderly patients. ⋯ It is most important to diagnose delirium early and to search for its cause without delay as this may be life-saving in some patients and may help avoid injury in others. This syndrome, long neglected by investigators, calls for vigorous research to establish its epidemiology, pathogenesis, and long-term outcome.