The Psychiatric quarterly
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Neuroleptic malignant syndrome (NMS) continues to be an unpredictable and rare, but potentially fatal complication of antipsychotic medications. Presumptively linked to dopamine blockade, it nonetheless occurs in patients receiving newer atypical antipsychotics. The features of NMS, its pathophysiology, differential diagnosis, clinical course, risk factors, and morbidity and mortality are reviewed. ⋯ Guidelines for using these agents are presented. Electroconvulsive therapy, also somewhat controversial, is identified as a second line of treatment. Finally, management of the post-NMS patient is also reviewed.
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The issues discussed in this article introduce and examine topics related to physicians' health which are salient in their clinical usefulness or their heuristic value in planning future research. Physicians in general possess physical, emotional and intellectual strengths that are needed to face high stress and low social support. Physicians are also less likely to seek routine medical care. ⋯ These factors require rigorous investigation to establish their role. Clinical approaches and techniques discussed include the incubation period for a Substance Use Disorder, initial high tolerance, state dependent learning, and the signal properties of drugs. As recovery progresses it is postulated that it becomes increasingly important to deal with substitute addictions and family of origin issues.
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The Psychiatric quarterly · Jan 1998
Review Historical ArticleAn update on the impact of gun control legislation on suicide.
The authors review recent literature examining the impact of gun control legislation on suicide rates. ⋯ The findings support gun control measures as a strategy for reducing suicide rates.
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Dementing disorders are found most commonly in the elderly. However, the approaches derived from the diagnosis and management of these patients exemplify principles which can equally well be applied to the management of psychiatric disorders in younger patients. These principles include the process of syndromic diagnosis, the need for multi-dimensional assessment, the recognition of the interaction of biological and psycho-social factors in the etiology and treatment of psychiatric symptoms and the crucial role of the family in the management of patients with dementia. In this paper these principles are discussed.
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The Psychiatric quarterly · Jan 1995
From conversion to coercion: the police role in medication compliance.
This paper examines the role of the police in supporting community based mental health services for the chronically mentally ill in a mid-sized midwestern city. Cooperation between the police and mental health system, as reflected in training and procedural agreements for emergency evaluations and hospitalization, achieves the conversion of the police to a medical model view of mental illness which stresses the importance and effectiveness of medication compliance so that the police will act upon this belief in their handling of the mentally ill. ⋯ Erosion of the police belief in the effectiveness of community mental health, and the resulting change in practices, may provide an important, yet partial, counterbalance to the control exerted by the medical model. The availability of police authority to assure compliance, or in some cases to reinforce the consequences of non-compliance with medication, raises questions about police-mental health relationships that are too cooperative.