General hospital psychiatry
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Gen Hosp Psychiatry · Nov 1998
Determinants of psychotropic drug usage in a general intensive care unit.
During a 3-month period, determinants of psychotropic drug utilization (sex, age, length of stay, reason for admission, disease severity) and data on psychotropic consumption (type of medication--antidepressants, benzodiazepines and antipsychotics--dosage and length of treatment) were retrospectively collected in a general intensive care unit of a Dutch university hospital. Daily exposure to psychotropics was standardized in number of Defined Daily Doses (DDD). Benzodiazepines were used by 35.8% of all patients (137) during their stay in the ICU whereas 17.5% of all patients used a neuroleptic agent. ⋯ High doses of benzodiazepines (9.9 DDDs) and low doses of antipsychotics (0.5 DDDs) were prescribed, which probably reflect the unusual nature of this critically ill group of patients compared with the reference group for DDD's. Clear patterns of determinants of psychotropic drug use in ICU patients were found and both benzodiazepines, antipsychotics and combined use of these agents could be associated with the determinants assessed. The time patterns we found in terms of length of stay give clues for further investigations in order to rationalize psychotropic drug use in the management of severely ill and complex patients.
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Gen Hosp Psychiatry · Sep 1998
Letter Case ReportsCase of psychosis due to prednisone-clarithromycin interaction.
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Gen Hosp Psychiatry · Sep 1998
ReviewAwareness during anesthesia and posttraumatic stress disorder.
It has been estimated that approximately 30,000 patients a year suffer awareness or consciousness during anesthesia. This paper reviews existing knowledge of the psychological impact and psychiatric sequelae of awareness during anesthesia. Literature on awareness and memory during anesthesia, traumatic memory, and posttraumatic stress disorder (PTSD) was reviewed using computer searches, books, and referenced articles. ⋯ Waking up during anesthesia, especially if the patient experienced pain, is a traumatic event which places the patient at risk for developing PTSD. Awareness-induced PTSD must be considered for patients who present for mental health treatment following surgery. The advantages of light anesthesia must be balanced against the risk of awareness-induced PTSD.
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Gen Hosp Psychiatry · Mar 1998
Case ReportsJoint care admissions to a psychiatric unit: a prospective analysis.
Despite developments in general hospital liaison psychiatry over the past 20 years, joint care still remains underdeveloped in Europe. Psychiatry continues to move from the mental hospital to the general hospital unit without the parallel evolution of combined medical and psychiatric. An inpatient unit that provides both medical and psychiatric care may provide an essential integration of care that can benefit a select group of patients. ⋯ It was used predominantly by patients following acts of deliberate self-harm. Joint care allowed a comprehensive assessment and initiation of treatment of this patient group as well as a learning experience for medical and nursing staff. The inclusion of such a unit is a worthwhile consideration in any general hospital psychiatric service, with advanced planning easing staff workload.
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Gen Hosp Psychiatry · Sep 1997
Comparison of child psychiatric patients in hospital and community clinics in Hong Kong.
This is a prospective study comparing a consecutive sample of child psychiatric patients at a community child mental health clinic (N = 56) and hospital clinic (N = 42) in Hong Kong. The subjects and their parents were studied with standardized questionnaires and semistructured interviews at their first visits to the clinics. A review of the treatment received was conducted 15 months later. ⋯ Subjects in both settings had very similar previous help-seeking behaviors. The findings suggested that the community clinic attracted disturbed children of similar backgrounds. The community child mental health clinic appeared to be a viable alternative in providing psychiatric care to children in Hong Kong.