The Journal of clinical psychiatry
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To examine the relationship between sleep loss and confusion after open-heart surgery, 27 consecutive patients were monitored 1 day preoperatively and 5 days postoperatively with the Folstein Mini-Mental State examination, a modified sleep latency test, and a sleep log. Confusion (low Mini-Mental State scores) peaked on postoperative Days 1 and 2 and correlated with insomnia (sleep time) during the following night but not during the preceding night. The results suggest that sleep loss is not the cause but, rather, a consequence of postcardiotomy confusion. Confusion, not insomnia, should be the focus of treatment.
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The authors report a case of a 55-year-old man undergoing a triazolam withdrawal syndrome that was recognized and treated with high doses of benzodiazepines, but the patient nevertheless developed seizures. Reasons for the occurrence of these seizures despite treatment are discussed within the context of the differential potency that exists among benzodiazepines in binding to central and peripheral benzodiazepine receptors.
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Three acutely psychotic patients with psychomotor excitement and agitation were rapidly sedated following intramuscular injections of 2.5 mg to 3 mg of midazolam. The use of midazolam, a short- and rapid-acting benzodiazepine preparation, in a psychiatric emergency room setting is discussed.
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Comparative Study Clinical Trial Controlled Clinical Trial
An outpatient evaluation of phenelzine and imipramine.
Phenelzine and imipramine were evaluated in a 5-week double-blind study of outpatients with major depression. Median daily doses of phenelzine 75 mg and imipramine 150 mg were employed. ⋯ Both drugs produced an equal overall effect, as measured by the Hamilton Rating Scale for Depression (HAM-D) and the Beck Depression Inventory (BDI). When patients were grouped on the basis of panic attack symptoms, phenelzine was found to be more effective than imipramine (p less than .05 for all patients on the BDI; p less than .05 for women on both rating scales).
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Case Reports
ECT as a treatment alternative for patients with symptoms of neuroleptic malignant syndrome.
The use of ECT as a treatment alternative in a clinical situation in which it is difficult to determine whether the patient is suffering from neuroleptic malignant syndrome (NMS) or an evolving catatonic state is investigated. Fourteen cases from the literature are reviewed and 3 new cases are presented. In 6 cases, ECT was rapidly effective in treating symptoms of NMS, but cardiac arrhythmias were reported in 4 cases. There was no evidence of malignant hyperthermia (MH) in patients receiving succinylcholine, suggesting that an association between NMS and MH may not be clinically relevant in patients being treated with ECT.