Ann Acad Med Singap
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Ann Acad Med Singap · Apr 2020
ReviewThe Link Between Amitriptyline and Movement Disorders: Clinical Profile and Outcome.
Amitriptyline (AMT) is a tricyclic antidepressant. In this review, we evaluate the clinical and epidemiological profile, pathological mechanisms and management of AMT-associated movement disorders. ⋯ Amitriptyline is associated with various movement disorders, particularly myoclonus, dystonia and dyskinesias. Stutters and restless legs syndrome are some of the less common associations.
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Ann Acad Med Singap · Apr 2020
Recovery in Psychosis: Perspectives of Clients With First Episode Psychosis.
Recovery from psychosis relates to connectedness, hope for the future, identity, meaning in life and empowerment. The process of recovery is often described as gradual and non-linear, with many stages and turning points, and without a definitive end point. This qualitative study aims to understand what recovery means to clients, to better understand their unique recovery process and what helps in recovery among clients with lived experience of first episode psychosis (FEP) in a developed Asian setting. ⋯ The emergent themes provide an understanding of the meaning of recovery to persons with FEP, their experiences as they proceed with their recovery journey and factors they found helpful. The importance of acceptance of the condition and the personal role the individual plays in his or her own recovery was evident in the narratives of the participants. The study suggests a need to incorporate recovery-relevant approaches right from the first episode of psychosis.
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Ann Acad Med Singap · Apr 2020
ReviewSedation and Delirium in the Intensive Care Unit-A Practice-Based Approach.
Critically ill patients often require sedation for comfort and to facilitate therapeutic interventions. Sedation practice guidelines provide an evidence-based framework with recommendations that can help improve key sedation-related outcomes. ⋯ More effort is required to develop a practical, time-weighted sedation scoring system. Emphasis on a balanced, multimodal appraoch that targets light sedation from the early phase of acute critical illness is important to achieve optimal sedation, lower mortality, shorten time on ventilator and reduce delirium.
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Migraine is one of top 5 medical conditions that contribute to Years Lived with Disability and affects approximately 1 billion people from around the world. To date, preventive treatment and acute therapies for migraine are limited, have undesirable side effects and are poorly tolerated in patients. In the last few decades, considerable advances in our understanding of migraine and its pathophysiology have paved the way for the development of targeted treatment options. ⋯ Serotonin 5-HT1F receptor agonists-namely ditans-have also been developed to treat acute migraine. Lastly, non-invasive neuromodulation offers another treatment option for migraine patients who prefer treatments that have fewer side effects and are well tolerated. In this review, we discussed emerging treatment options for migraine that were made available in recent years.
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Ann Acad Med Singap · Apr 2020
ReviewExtracorporeal Membrane Oxygenation for Severe Respiratory Failure During Respiratory Epidemics and Pandemics: A Narrative Review.
Epidemics and pandemics from zoonotic respiratory viruses, such as the 2019 novel coronavirus, can lead to significant global intensive care burden as patients progress to acute respiratory distress syndrome (ARDS). A subset of these patients developed refractory hypoxaemia despite maximal conventional mechanical ventilation and required extracorporeal membrane oxygenation (ECMO). This review focuses on considerations for ventilatory strategies, infection control and patient selection related to ECMO for ARDS in a pandemic. We also summarise the experiences with ECMO in previous respiratory pandemics. ⋯ The role of ECMO in managing ARDS during respiratory pandemics continues to grow. This is supported by efforts to redefine optimal ventilatory strategies, reinforce infection control measures and enhance patient selection.