General hospital psychiatry
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Gen Hosp Psychiatry · Jul 2003
Clinical TrialTreatment for delirium with risperidone: results of a prospective open trial with 10 patients.
Delirium is a common psychiatric illness among medically compromised patients. There is an increasing opportunity to use atypical antipsychotics to treat delirium. The effects of these drugs on delirium, however, the most appropriate way to use them, and the associated adverse effects remain unclear. ⋯ However, sleepiness (30%) and mild drug-induced parkinsonism (10%) were observed; the symptom of sleepiness was a reason for not increasing the dose. One patient responded to a dose as low as 0.5 mg/d, so it is recommended that treatment start at a low dose, which may then be increased gradually. This trial is a preliminary open study with a small sample size, and further controlled studies will be necessary.
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Gen Hosp Psychiatry · Jul 2003
Incidence and correlates of near-death experiences in a cardiac care unit.
Near-death experiences, unusual experiences during a close brush with death, may precipitate pervasive attitudinal and behavior changes. The incidence and psychological correlates of such experiences, and their association with proximity to death, are unclear. We conducted a 30-month survey to identify near-death experiences in a tertiary care center cardiac inpatient service. ⋯ Near-death experiences were reported by 10% of patients with cardiac arrest and 1% of other cardiac patients (P<.001). Near-death experiencers were younger than other patients (P=.001), were more likely to have lost consciousness (P<.001) and to report prior purportedly paranormal experiences (P=.009), and had greater approach-oriented death acceptance (P=.01). Near-death experiencers and comparison patients did not differ in sociodemographic variables, social support, quality of life, acceptance of their illness, cognitive function, capacity for physical activities, degree of cardiac dysfunction, objective proximity to death, or coronary prognosis.
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Gen Hosp Psychiatry · Jul 2003
The Institute of Medicine "Chasm" report: implications for depression collaborative care models.
The Institute of Medicine report "Crossing the Quality Chasm: A New Health Care System for the 21st Century" describes the barriers in the American health care system to improving quality of care and outcomes of chronic illness. This article describes how depression collaborative care models as well as newer research aimed at organizational and economic issues have addressed these barriers in order to improve outcomes for patients with depression in primary care systems.