The Journal of clinical psychiatry
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Combinations of antidepressants with both serotonergic and noradrenergic activity may be especially effective and thus useful in treating refractory patients and severely depressed patients. In the current report, studies of combinations of serotonin selective reuptake inhibitors (SSRIs) and noradrenergic tricyclics or of SSRIs and bupropion are reviewed, and practical issues pertaining to their use are discussed.
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Depression is underrecognized, underdiagnosed, and undertreated, with resultant increases in unnecessary suffering, morbidity, and mortality. A decade of admonitions to practitioners to improve our practices has made little impact on these recognized deficiencies. ⋯ Computer interviews gather information from patients and give information to them, complementing, supplementing, and reinforcing clinician functioning. Available computer programs can help us reduce the gap between what is possible and what is practiced-a laudable goal.
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Violence and persistent aggression are serious problems in the general population and among certain psychiatric patients. Violence and persistent aggression have been associated with suicidal ideation and substance abuse, characteristics of chronically ill, and in many instances, treatment-resistant schizophrenia individuals. Assessment of dangerousness in psychiatric patients involves evaluation of sociodemographic and clinical factors. ⋯ Unfortunately, this approach subjects patients to numerous side effects, including the extrapyramidal symptoms associated with the use of conventional antipsychotics. This paper will review evidence for the efficacy of clozapine in the treatment of aggression and violence in the treatment-refractory patient. The reduction in violence and persistent aggression with clozapine treatment should improve the chances for integration of the schizophrenia patient into the community and provide cost savings to society.