Delirious mania in the elderly.

Delirious mania is a clinical syndrome in which the signs and symptoms of delirium manifest themselves in the context of a manic episode. Though there have been numerous descriptions and case reports of this syndrome, all have described mania as the presenting feature, with signs of delirium developing subsequently, and none of the vignettes have involved elderly patients. We report two cases of elderly individuals with mania who initially presented as in a delirium.

Electroconvulsive therapy in the acute poststroke period.

A depressed patient was successfully treated with electroconvulsive therapy approximately 7 to 14 days after a cerebellar stroke. This report documents an uncomplicated use of electroconvulsive therapy that was well tolerated and effective in a course of eight treatments in the acute poststroke period.

ECT for major depression and mania with advanced dementia.

Two patients with advanced dementia and severe affective disorders were successfully treated with electroconvulsive therapy (ECT) without significant adverse effects. These reports illustrate that ECT can be effective for depression and mania even when complicated by moderate or severe dementia.

Midazolam attenuates ketamine-induced abnormal perception and thought process but not mood changes.

Purpose: To determine the effects of midazolam, 30 ngxmL(-1), on altered perception, mood, and cognition induced by ketamine.

Methods: After ketamine was administered to achieve target concentrations of 50, 100, or 150 ngxmL in 11 volunteers, perception, mood, and thought process were assessed by a visual analog scale. Mini-Mental State examination (MMSE) assessed cognition.

Hair loss in psychopharmacology.

Medication-induced alopecia is an occasional side effect of many psychopharmaceuticals. Most of the mood stabilizer and antidepressant drugs can lead to this condition. Some antipsychotic and antianxiety agents induce alopecia.

Psychiatric aspects of parathyroid disease.

Parathyroid diseases can present with psychiatric symptoms and can be recognized through determinations of serum electrolytes, especially the calcium level. Psychiatric evaluations should include a serum calcium concentration test, which is also essential in reassessment of patients poorly responsive to mental illness treatment. A magnesium and a phosphate assay may also be diagnostically helpful.

Prompt differentiation of Addison's disease from anorexia nervosa during weight loss and vomiting.

An 18-year-old white woman had nausea, vomiting, weight loss, and a diagnosis of anorexia nervosa. Copper-colored skin was noted on physical examination, and serum chemistry values were normal. Subsequent fever, disorientation, and confusion led to the discovery of Addison's disease, which responded well to corticosteroid replacement therapy.

Divalproex: a possible treatment alternative for demented, elderly aggressive patients.

Elderly, demented people often exhibit behavioral dyscontrol. Divalproex appears to be safe and effective in the management of this presentation. Twelve cases treated with divalproex all responded with improved emotional control.

Dying, death, and grief. Helping patients and their families through the process.

When a patient has terminal illness and death is imminent, grief is a normal reaction. Primary care physicians can help patients and their families by talking with them about the five stages of grief (denial, anger, bargaining, depression, and acceptance), providing grief counseling and appropriate pharmacotherapy, and being supportive. Grief often manifests with features similar to those of depression, and it is critical for the clinician to distinguish between the two.

How to treat coexistent mental illness and substance abuse.

Integration of mental illness and substance abuse treatments is important for patients with "dual diagnosis", the coexistence of an emotional ailment and a chemical dependency. Such comorbidity is usually associated with a poor prognosis. Both disorders require appropriate therapy so that remission of psychiatric symptoms and maintenance of sobriety become reachable goals for these individuals.

ECG intervals in acute bipolar and schizophrenic relapse.

Psychosis in general and acute relapse of bipolar illness, in particular, are associated with elevated catecholamine excretion, cardiovascular changes, and changes in intracellular calcium concentration. In an effort to determine if these changes result in observable ECG abnormalities, we retrospectively examined ECG parameters of acutely disturbed bipolar and schizophrenic patients. There were no discrete patterns of abnormalities, and no significant differences were observed between the two patient groups.

Treatment of insomnia. Getting to the root of sleeping problems.

Insomnia may be periodic and transient, as caused by situational stress, or persistent, as caused by a chronic sleep disorder. Physicians can gain much information concerning the type, probable cause, onset, and duration of insomnia through history taking. A sleep diary may reveal helpful information, and input from the patient's sleeping partner can also be valuable.

A two-year follow-up on the effects of a smoking ban in an inpatient psychiatric service.

The effects of prohibiting cigarette smoking on the behavior of patients on a 25-bed psychiatric inpatient unit were assessed immediately after implementation of a smoking ban and two years later. No major behavioral disruptions were observed after the ban. The number of calls for security assistance, physical assaults, instances of leather restraints and of seclusions, and discharges against medical advice did not increase significantly immediately after the restriction on smoking or two years later.

Clues to depression in primary care practice.

Depression is a common but highly treatable mood disorder. Unfortunately, two thirds of depressed patients may never receive appropriate intervention. Because of individual and societal barriers to the diagnosis, depressive symptoms often go unrecognized.

Alcoholism. Taking a preventive, public health approach.

Alcoholism is a common, chronic, often progressive disorder that has negative effects on a patient's health and severe consequences for society as well. A positive, public health approach that integrates medical, psychological, and social therapies can lead to improved outcomes for patients who abuse alcohol. Physicians can play an important role by educating patients to prevent alcohol abuse from starting, being alert to the risk factors, recognizing the signs of alcoholism (especially during its early stages), and initiating interventions designed to halt progression of this disease.

Delirium. Quick recognition, careful evaluation, and appropriate treatment.

Delirium is a common medical condition, especially in elderly hospitalized patients. The syndrome is characterized by a short course of confusion and changes in perception and behavior. Early detection can be enhanced by routine assessment of cognitive functioning in hospitalized patients, especially those at risk for delirium.

Domestic violence. Do you know when and how to intervene?

Physicians must be alert to the possibility of abuse within the family and home. They should be well prepared to help victims begin the transition to a safer environment. An awareness of the prevalence of abuse and a high index of suspicion are the most effective clinical tools for assisting victims of domestic violence.

ECT-induced seizure durations.

Electroconvulsive therapy (ECT) efficacy is related to the stimulus intensity and clinically associated with the duration of the induced seizure. Convulsions lasting 30 to 60 seconds are conventionally considered to be of optimal length, and generally are achieved by applying routine ECT technique. An ictus slightly shorter or longer is usually also therapeutically satisfactory.

Chronic schizophrenia.

Preview Perhaps one fourth of patients with schizophrenia respond only partially to standard neuroleptic therapy. Until recently, the only pharmacologic option for such patients was adjunctive treatment with other psychotropic drugs. Now two newer drugs-clozapine and risperidone-offer hope to patients with treatment-resistant schizophrenia.