The Psychiatric clinics of North America
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Psychiatr. Clin. North Am. · Mar 1992
ReviewThe pharmacologic treatment of conduct disorders and rage outbursts.
Although this article focuses on psychopharmacology, pharmacotherapy is only part of a comprehensive treatment program. Treatment should be individualized to the patient's condition and level of intellectual functioning (e.g., conduct disorder, mental retardation). Clinicians should be acquainted with the Food and Drug Administration's regulations and the Physician's Desk Reference's guidelines. ⋯ In conclusion, there is a need for systematic investigation of the effectiveness and safety of psychoactive agents in children and adolescents with aggressiveness, explosiveness, and rage outbursts. There is some supportive evidence that some patients with these target symptoms are good responders to certain drugs. Future research should compare pharmacotherapy to psychosocial treatment and the combination of both.
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Psychiatr. Clin. North Am. · Mar 1992
ReviewThe pharmacologic treatment of child and adolescent depression.
The evidence of continuity of child and adolescent depression into adult depression, of familial transmission of this disorder from parent to child, of psychobiologic similarity, and the similar syndromic picture all strongly argue that, by extrapolation, pharmacologic agents with proven efficacy in adult depression are likely candidates for the pharmacologic treatment of children and adolescents with this disorder. On the other hand, differences in kinetics, in cognitive maturity, and in brain maturity effecting mechanisms thought to be important in the control of affect all strongly argue that even if the disorder is related, the pharmacologic response may be different. As yet, the efficacy or lack of efficacy of cyclic antidepressants in either children or adolescents with MDD have not been established.
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The disruption of multiple neurotransmitter systems in Alzheimer's disease plays an important role in the pathophysiology of cognitive and behavioral disturbances associated with the illness. The central cholinergic system is significantly disrupted in a fashion that correlates with cognitive impairment. This article describes drugs, such as scopolamine, that selectively affect the cholinergic system and model aspects of Alzheimer's disease phenomenology in both animals and humans. Drugs that induce cognitive changes but whose chemical mechanisms are not well understood are presented as alternative pharmacologic models of Alzheimer's disease.
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As we are learning to master the methods of quality assurance, a new conceptual approach focused on quality improvement is being advocated. But this new approach is not a derailment for health care practitioners committed to improve patient care quality. Rather, it is a progressive step that builds upon the concepts and methods of quality assurance. ⋯ The monitoring and evaluation process described in Joint Commission standards is a method for establishing priorities and using indicators to improve the quality of patient care. This method can be used to focus case-based review of care and to establish baselines for continuous improvement. This conceptual approach that emphasizes quality improvement and the use of the monitoring and evaluation process is guiding the Joint Commission's development of clinical indicators and revision of its standards and survey process to help health care organizations in the transition from quality assurance to quality improvement.
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Psychiatr. Clin. North Am. · Mar 1990
Introducing quality assurance to a state hospital medical staff.
Establishing a quality assurance program in a developing state hospital requires considering the unique problems of being a physician in such a setting. The hospital and medical staff must be developed to the point where consideration of quality of care is a feasible goal. Managers can take advantage of the interests of individual medical staff as well as serendipitous factors promoting a program.