General hospital psychiatry
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Gen Hosp Psychiatry · Jul 2008
Review Comparative StudyLife-threatening serotonin toxicity due to a citalopram-fluconazole drug interaction: case reports and discussion.
To discuss two cases of life-threatening serotonin toxicity due to a drug interaction between citalopram and fluconazole and to review the pertinent literature. ⋯ Consultation-liaison psychiatrists and oncologists should be aware of this preventable and underrecognized interaction. Citalopram should be stopped or substituted prior to the concurrent administration of fluconazole, and in the event of toxicity, treatment with cyproheptadine has a favorable risk-benefit ratio despite a lack of randomized controlled data to support its use.
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Gen Hosp Psychiatry · Jul 2008
Comparative StudyCerebrospinal fluid homovanillic acid is correlated to psychotic features in neurological patients with delirium.
The aim of this study was to determine if cerebrospinal fluid (CSF) levels of homovanillic acid (HVA) are related to the clinical features of delirium in a group of patients with acute onset neurological illness. ⋯ Our results suggest that psychotic symptoms in delirious patients may be related to increased dopamine neurotransmission, as reflected by increased CSF HVA concentration, providing direct evidence to support the dopaminergic theory of psychosis.
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Gen Hosp Psychiatry · Jul 2008
Comparative StudyClinical and nonclinical predictors of test ordering in psychiatric emergency.
This naturalistic prospective study explored the predictors of laboratory test ordering in a psychiatric emergency department. ⋯ Clinicians should be aware of possible biases when assessing the need of laboratory tests in patients presenting with psychiatric complaints.
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Gen Hosp Psychiatry · Jul 2008
Comparative StudyLower decision threshold for doctor visits as a predictor of health care use in somatoform disorders and in the general population.
Somatization is related to elevated health care utilization (HCU) and high health care costs. However, it is unclear whether HCU in somatizers and nonsomatizers in the general population is determined by existing symptoms or by lower thresholds for doctor visits. ⋯ Not only symptoms per se but also a lower decision threshold for doctor visits contribute to increased HCU. Psychopathological and demographic variables can further predict HCU in somatizing persons and controls. Although somatization and reduced thresholds for doctor visits are associated, they have to be distinguished from each other and contribute independently to increased costs.
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To raise awareness of a rare but serious adverse effect of a commonly used medication. ⋯ The new quinolone derivatives (levofloxacin, sparfloxacin, grepafloxacin, trovafloxacin, gatifloxacin and moxifloxacin), also called gyrase inhibitors, are known for their potential to cause central nervous system-related adverse effects, including headache, dizziness and insomnia. Risk factors for neurotoxicity include renal insufficiency, underlying central nervous system (CNS) disease and increased CNS penetration of drug. Acute delirium resulting from levofloxacin therapy is an exceedingly rare complication that has been thought to occur more commonly in elderly patients. Here, we describe levofloxacin-induced delirium with psychotic features in a relatively young, otherwise healthy female.