Psychosomatics
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Randomized Controlled Trial Comparative Study Clinical Trial
A double-blind trial of risperidone and haloperidol for the treatment of delirium.
To compare the clinical efficacy of haloperidol and risperidone for the treatment of delirium, the authors performed a double-blind comparative study. Twenty-eight patients with delirium were recruited and randomly assigned to receive a flexible-dose regimen of haloperidol or risperidone over 7 days. The severity of delirium was assessed by using Memorial Delirium Assessment Scale scores. ⋯ In addition, there was no significant difference in the frequency of response to the drugs between the two groups. One patient in the haloperidol group experienced mild akathisia, but no other patients reported clinically significant side effects. These data show no significant difference in the efficacy or response rate between haloperidol and risperidone in the treatment of delirium.
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This study investigated the clinical factors associated with a wish to hasten death among patients with advanced cancer receiving palliative care, with a focus on the role of clinician-related factors. Patients were grouped into high- and low-scoring groups on the basis of their wish to hasten death; doctor-patient pairs were formed. ⋯ When these variables were combined with patient factors identified in a previous study, the model significantly predicted a wish to hasten death with the following variables-patient factors: a higher perceived burden on others, higher depressive symptom scores, and lower family cohesion; physician factors: the doctor willing to assist the patient in hastening death (if requested and legal), the doctor's perception of lower levels of optimism and greater emotional distress in the patient, and the doctor having less training in psychotherapy; and the setting of care: recent admission to a hospice. The findings support the multifactorial influences on the wish to hasten death and suggest that the role of the clinician is a vital context within which the wish to hasten death should be considered.
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A new 53-item instrument for the evaluation of treatment effects in somatoform disorders, the Screening for Somatoform Symptoms-7 (SOMS-7), is presented. It covers all somatic symptoms mentioned as occurring in somatization disorder, according to DSM-IV and ICD-10. A group of 325 patients was assessed at the beginning and end of treatment to compute scores of reliability and validity. ⋯ These indices discriminated patients fulfilling complete criteria for somatoform disorders, patients with somatization syndrome, and patients with other mental and psychosomatic disorders. The instrument confirmed symptom reductions between admission and discharge, while in another group composed of wait-listed patients, no significant decrease in symptoms was observed. In sum, the SOMS-7 seems to be a comprehensive, reliable, and valid instrument for the evaluation of treatment effects in patients with somatoform disorders.
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The sensitivity and specificity of the Cognitive Test for Delirium, which was originally developed for use in intensive care units, were tested in a group of patients with traumatic brain injury who were admitted to a neurorehabilitation center. Sixty-five consecutive patients were evaluated weekly by using the DSM-IV criteria for delirium and the Cognitive Test for Delirium. ⋯ Analysis of the receiver operating characteristic curve suggested an optimum cutoff score of less than 22 for identification of delirium by using the Cognitive Test for Delirium, with a sensitivity of 72% and a specificity of 71% compared with the DSM-IV diagnosis. The results suggest that the Cognitive Test for Delirium provides an acceptable level of differentiation between delirious and nondelirious patients with traumatic brain injury.