Current psychiatry reports
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Curr Psychiatry Rep · Jul 2003
Comparative StudySchizoaffective disorder: clinical aspects, differential diagnosis, and treatment.
Schizoaffective disorders are a clinical reality and their concept has a long history, but there are still problems regarding their diagnostic definition and nosologic categorization. The present definitions of the International Classification of Disease and the Diagnostic and Statistical Manual of Mental Disorders are not sufficient enough to define schizoaffective disorders, especially because of deficits on the longitudinal axis. Schizoaffective disorders occupy a position between schizophrenia and pure mood disorders, especially regarding prognosis and premorbid and sociodemographic variables. ⋯ Suicidal symptomatology is extremely frequent in patients with schizodepressive episodes. The most severe type of schizoaffective disorders is the schizoaffective mixed type. Schizoaffective patients with mixed episodes retire more frequently and at younger ages than other patients with bipolar disorder.
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Curr Psychiatry Rep · Jun 2002
ReviewDelirium: an important (but often unrecognized) clinical syndrome.
Delirium is a clinical syndrome characterized by the acute onset of a disturbance in consciousness accompanied by a reduced ability to focus, sustain, or shift attention. It may foreshadow impending death in as many as 25% of hospitalized inpatients and may be a source of significant morbidity in those who present with this syndrome. ⋯ This paper will address this complex condition, focusing on its history, definition, epidemiology, pathophysiology, recognition, risk factors, and clinical quantification. Its prevention and treatment will be covered elsewhere in this journal.
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The mainstay of the pharmacologic management of delirium remains typical antipsychotics, primarily haloperidol. Typical antipsychotics are associated with significant side effects, particularly in the elderly. This article reviews the literature on the use of both typical and atypical antipsychotics in the management of acute delirium, with a focus on the elderly. ⋯ Anticholinergic toxicity is especially problematic in delirious, demented patients, because most dementias are associated with pre-existing deficiencies in cholinergic neurotransmission. These issues will be reviewed for typical antipsychotics as well as the emerging literature on the use of atypical antipsychotics-- risperidone, olanzapine, and quetiapine--for pharmacologic management of acute delirium. Data from two studies conducted at the Wesley Woods Center at Emory University will be briefly reviewed as they constitute the largest series to date investigating the pharmacologic management of delirious demented patients.
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Families have always cared for relatives with dementia, but scientific advances in diagnosis, management, and treatment will make caring more challenging as more people are diagnosed in early stages and more live longer in severe stages with better health care. This paper discusses the increasing prevalence, the economic value and cost of caregiving, the impact of caregiving in families with and without dementia, the subjective experience of dementia and quality of life, the ethical challenges of clinician-family partnerships, the complexity of family systems and processes that impact care patterns, homicide-suicide in caregiving, long-term care staff training, and theoretic models.