The Journal of clinical psychiatry
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Practitioners need to work effectively with managed care personnel to provide the best possible mental health care to patients with panic disorder. To do so, physicians must become familiar with the organization and administrative principles common to most managed care plans. Specific strategies can be used when working with managed care personnel. These strategies include using data to demonstrate that effective mental health treatment can reduce the social and economic costs of panic disorder.
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Clinical Trial Controlled Clinical Trial
Treatment of recent trauma survivors with benzodiazepines: a prospective study.
Most types of psychotropic drugs have been tried in the treatment of chronic posttraumatic stress disorder (PTSD), but have yielded limited results. Theory and retrospective research predict that early treatment may be more efficacious. Specifically, high-potency benzodiazepines have been recommended for the treatment of acute responses to trauma and for prevention of PTSD. This study prospectively evaluates the effect of early administration of benzodiazepines on the course of PTSD and PTSD symptoms. ⋯ Contrary to expectations, the early administration of benzodiazepines to trauma survivors with high levels of initial distress did not have a salient beneficial effect on the course of their illness, while reducing physiologic expression of arousal.
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Asystole is an uncommon but potentially fatal complication of electroconvulsive therapy (ECT). Although the risk of asystole can be reduced with anticholinergic medications, the recent emphasis on new modifications of technique (first, the use of subconvulsive stimuli to titrate the seizure threshold, and second, pretreatment with intravenous beta-blockers) may increase the risk of asystole in ECT patients. ⋯ If risk factors contributing to asystole are reduced and adequate doses of intravenous atropine are on hand, a patient's ECT treatments need not be interrupted.
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Randomized Controlled Trial Clinical Trial
Electroconvulsive therapy and resistant depression: clinical implications of seizure threshold.
Patients with major depressive disorder (MDD) were treated with electroconvulsive therapy (ECT) to determine (1) variability of initial seizure threshold, (2) factors that influence seizure threshold, (3) change in seizure threshold during the ECT course, and (4) relationship of seizure threshold to antidepressant effects. ⋯ (1) Initial seizure threshold for pulse bilateral ECT is highly variable and not yet amenable to accurate prediction. (2) Stimulus titration allows threshold to be determined on an individual basis and dosage for subsequent treatments to be defined. (3) Seizure duration is of limited value as a sole criterion for the adequacy of treatment when initial threshold is unknown and/or electrical doses that substantially exceed threshold are used. (4) With moderately suprathreshold bilateral ECT, a relationship of seizure threshold to antidepressant response is not demonstrable.
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Review
Atypical antipsychotic drugs as a first-line treatment of schizophrenia: a rationale and hypothesis.
Clozapine represented the first significant advance in the pharmacotherapy of schizophrenia since the introduction of conventional antipsychotic drugs in the 1950's. Despite its superior efficacy and potential to reduce substantially the morbidity of schizophrenia and improve the outcomes, of patients, clozapine has not been used on a widespread basis or as a first-line treatment due to its potential for agranulocytosis. ⋯ If we accept the premise that atypical antipsychotic drug provide superior efficacy, reduced side effects, and the prospect of better compliance, their greatest impact may be when used in patients at the beginning of their illness. The following article provides a rationale and hypothesis for the use of atypical antipsychotic drugs as a first-line treatment of schizophrenia.