Canadian journal of psychiatry. Revue canadienne de psychiatrie
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Letter Case Reports
Spiramycin-associated acute dystonia during neuroleptic treatment.
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Review
Psychotropic medications and cytochrome P450 2D6: pharmacokinetic considerations in the elderly.
The genetically polymorphic cytochrome P450 2D6 isozyme (CYP2D6) is responsible for the metabolism of numerous psychotropic medications pertinent to the practice of geriatric psychiatry. Optimal use of psychotropics in the elderly requires a thorough understanding of the determinants of marked variability in plasma concentrations. This review article will focus on basic pharmacokinetic considerations for elderly patients when psychotropics metabolized by CYP2D6, such as nortriptyline and desipramine, are prescribed. ⋯ Clinical measurement of CYP2D6 activity may potentially assist in prediction of doses required to achieve therapeutic plasma concentrations of psychotropics metabolized by CYP2D6 in individual patients. Although CYP2D6 activity does not change with age, the pharmacokinetics of psychotropics metabolized by CYP2D6 may change because of age-associated changes in hepatic blood flow, volume of distribution, and renal elimination of metabolites.
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To examine current concerns that in the Canadian single-payer mental health care system, the "rich worried well" (that is, wealthy individuals who are worried yet mentally well) may overuse psychiatric services, while low-income, uninsured mentally ill individuals may remain undertreated. The current study focuses on the mental health care in the Canadian region of Ottawa-Carleton, where a single-payer system provides universal access to mental health services, to assess how psychiatric services are provided by psychiatrists in private practice. ⋯ Our results suggest that outpatient psychiatric care delivered by private psychiatrists in a Canadian single-payer system targets primarily individuals with major psychiatric disorders and does not seem to favour "the worried well." Larger epidemiological studies with independent assessments of psychiatric populations are necessary to confirm our findings.
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Letter Case Reports
Zuclopenthixol acetate in a demented elderly patient with agitation.
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To describe the rationale, origins, and goals of a newly created academic division of general psychiatry within a university setting. ⋯ In an era of increasing academic subspecialization, the preservation of core skills in psychiatry and the recognition of the continuing public need for psychiatric generalists must be enshrined within academic training programs.