Benzodiazepine Use in Older Adults: Dangers, Management, and Alternative Therapies.

Several major medical and psychiatric organizations, including the American Geriatrics Society, advise against using benzodiazepines or nonbenzodiazepine hypnotics in older adults. Despite these recommendations, benzodiazepines continue to be massively prescribed to a group with the highest risk of serious adverse effects from these medications. This article summarizes legitimate reasons for prescribing benzodiazepines in the elderly, serious associated risks of prescribing them, particularly when not indicated, barriers physicians encounter in changing their prescription patterns, and evidence-based strategies on how to discontinue benzodiazepines in older patients.

The pediatric surgeon-patient relationship.

Though technical aspects of surgical practice are commonly emphasized, communication is the most frequent "procedure" employed by surgeons. A good patient-physician relationship enhances the quality of surgical care by improving outcomes and patient and family satisfaction. There are general principles that can enhance communication with all children and families.

Impact of dopamine agonists on compulsive behaviors: a case series of pramipexole-induced pathological gambling.

Background: Dopamine agonists (DAs), long used in treating Parkinson's disease and effective in relieving symptoms of restless legs syndrome, have frequently been reported to induce problematic compulsive behaviors (e.g., obsessive gambling, hypersexuality) in individuals who had never had difficulties with such behaviors before.

Do cheap internet drugs threaten the safety of the doctor-patient relationship?

During traditional office visits, trusted physicians give their patients careful and leisurely diagnostic attention, communicate sound and understandable clinical impressions and, more often than not, write prescriptions that can be filled at convenient neighborhood pharmacies. Or do they? In reality, harried doctors rush through appointments, leaving patients confused about prescriptions they cannot afford, either because their insurance plans do not cover the recommended medication or because they lack the cash to pay out of pocket for obscenely priced products. Internet pharmaceutical acquisition offers a cheap alternative.

Impacting quality of life for patients with advanced cancer with a structured multidisciplinary intervention: a randomized controlled trial.

Purpose: The primary goal of this study was to evaluate the feasibility and effectiveness of a structured, multidisciplinary intervention targeted to maintain the overall quality of life (QOL), which is more comprehensive than psychosocial distress, of patients undergoing radiation therapy for advanced-stage cancer.

Patients And Methods: Radiation therapy patients with advanced cancer and an estimated 5-year survival rate of 0% to 50% were randomly assigned to either an eight-session structured multidisciplinary intervention arm or a standard care arm. The eight 90-minute sessions addressed the five domains of QOL including cognitive, physical, emotional, spiritual, and social functioning.

Hospitalized patients and alcohol: who is being missed?

Research and clinical experience have shown that alcohol use disorders are neither sufficiently identified nor addressed in hospitalized patients. This study sought to quantify and localize these missed opportunities. The setting was an urban medical center with a Level 1 trauma designation.

Temporal competency in catatonia.

A catatonic patient without known relatives or advance directives faced possible death without electroconvulsive treatment (ECT). The authors describe using medication to restore capacity to permit the patient to give critical history and consent to potentially life-saving treatment. Even had a proxy been available, the jurisdiction in which he fell ill forbade substituted judgment for ECT, permitting only recipients themselves to consent.

The use of electroencephalography in psychiatry of the medically ill.

The psychiatrist considering recommending an EEG should look for acute changes in the history or examination suggestive of an organic cause. If he or she judges that the EEG will help to clarify or confirm the diagnostic impression already formulated, it is worth considering whether adding provocative maneuvers could increase the yield. The authors cannot overemphasize the importance of using the EEG in correlation to further inform old-fashioned clinical detective work already in process, particularly when the EEG could rule out a potential organic contributor to a psychiatric phenotype.

The Challenge of Empathy: A Pilot Study of the Use of Standardized Patients to Teach Introductory Psychopathology to Medical Students.

This pilot study compares standardized and actual psychiatric patients used to teach introductory psychopathology. In a blinded manner, students and psychiatric faculty interviewed both types of patients, using a small group format. Before and after the course, students and faculty completed a questionnaire about expectations and effectiveness.