The American journal of psychiatry
-
Three patients with restless legs syndrome, two of whom also had nocturnal myoclonus, responded well to treatment with low doses of opioids. The pathophysiology of the syndrome and the mechanism of opioids' therapeutic action are discussed.
-
A paraplegic man with no history of psychiatric illness developed psychosis and dyskinesia following abrupt withdrawal of baclofen; the symptoms resolved 72 hours after resumption of the drug. The psychosis and dyskinesia may have been a manifestation of baclofen's alteration of cerebral dopaminergic mechanisms.
-
Transient cognitive disorders (delirium and pseudodelirium) are highly prevalent among the elderly, especially those with brain damage. Delirium is a common feature of physical illness or drug intoxication in elderly patients and requires prompt medical attention. ⋯ Transient cognitive disorders must not be confused with dementia, a chronic syndrome. The author discusses clinical features, etiology, pathogenesis, diagnosis, and treatment of delirium and related transient disorders of cognition in the elderly.
-
In 1975 the World Health Organization began a multinational collaborative study of the feasibility and effectiveness of offering community-based mental health care in developing countries. Services were to be offered by primary health care workers in pilot study areas in seven countries. The authors discuss the philosophic and epidemiologic underpinnings of the study, the factors that helped the collaborative effort develop, and some of the issues that emerged. Areas for future study are outlined.
-
Nineteen patients believed to be in the terminal stages of cancer were evaluated for signs of delirium. Six patients improved; 13 who died during hospitalization were studied until their death. ⋯ In most patients, delirium was caused by multiple factors. The authors outline strategies for management of terminal cancer patients with delirium.