Safety and effectiveness of varenicline in a veteran population with a high prevalence of mental illness.

Background: Varenicline is a selective nicotinic receptor partial agonist used to aid in the process of smoking cessation. Research on varenicline's approval for marketing demonstrated that after 12 weeks of treatment, at least 44% of patients successfully quit smoking and, on average, 13% of individuals discontinued therapy due to an adverse drug event (ADE). Growing postmarketing data linked varenicline to an increase in neuropsychiatric symptoms.

Factors which influence tobacco use among junior enlisted personnel in the United States Army and Air Force: a formative research study.

Background: Despite the implementation of a host of tobacco control initiatives, tobacco use among active duty members of the U.S. Military remains high.

Ramelteon: a novel approach in the treatment of insomnia.

Objective: To review the pharmacology, pharmacokinetics, efficacy, and safety of ramelteon in the treatment of primary insomnia in adults, including elderly adults.

Data Sources: MEDLINE (1966-July 2008) and PsycINFO (1985-July 2008) literature searches were conducted to identify clinical data involving ramelteon. The manufacturer provided a summary of clinical data and abstracts of unpublished studies.

An analysis of messages about tobacco in the Military Times magazines.

The Military Times magazines are seen as an independent source of news and information on the military and are widely read by military members. Given the influence of Military Times as a powerful media outlet within the military and marketing to military personnel by the tobacco industry, we examined tobacco messages and advertisements in a one-year sample from each service. No advertisements for cigarettes or other forms of smoked tobacco were found in any issue published in 2005.

Role of mirtazapine in the treatment of antipsychotic-induced akathisia.

Objective: To evaluate the role of mirtazapine in the treatment of antipsychotic-induced akathisia.

Data Sources: MEDLINE (1966-February 2008) and PsycINFO (1967-February 2008) were searched using the terms akathisia and mirtazapine. A bibliographic search was conducted as well.

The role of venlafaxine in the treatment of obsessive-compulsive disorder.

Objective: To evaluate the published literature regarding the use of venlafaxine in the treatment of obsessive-compulsive disorder (OCD).

Data Sources: MEDLINE (1996-March 2004) and International Pharmaceutical Abstracts (1970-March 2004) were searched using the terms venlafaxine and obsessive-compulsive disorder. A bibliographic search was conducted as well.

Selecting a Selective Serotonin Reuptake Inhibitor: Clinically Important Distinguishing Features.

Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed to treat depression. Although these drugs presumably have the same mechanism of action, they vary in several clinically important ways, including how long they remain in the body and the extent to which they interfere with the metabolism of other medications. This article reviews the pharmacologic differences among SSRIs and how these differences may affect various aspects of treatment, such as dosing, administration, and discontinuation.

Volitional impairment and the sexually violent predator.

This article discusses psychiatry's limited conceptualization of volitional capacity and its application to sexually violent predator laws by exploring two legal opinions critical to predator case law (Kansas v. Hendricks and Kansas v. Crane).

The use of clonidine in post-traumatic stress disorder.

This case report examines the use of clonidine to successfully treat a child suffering from post-traumatic stress disorder (PTSD). This case shows an unintentional washout period that exemplifies a cause-effect relationship between clonidine and the inhibition of reenactment symptoms of PTSD.

Anabolic steroids: a review for the clinician.

The number of athletes self-administering ergogenic pharmacological agents to increase their competitive edge continues to be a problem. Most athletes using anabolic steroids (AS) have acquired a crude pharmacological database regarding these drugs. Their opinions regarding steroids have been derived from their subjective experiences and anecdotal information.

Successful management of prolonged gamma-hydroxybutyrate and alcohol withdrawal.

A 27-year-old man was admitted with tremulousness, diaphoresis, tachypnea (28 breaths/min), full-body rigidity, irritability, paranoia, and auditory and visual hallucinations 2 days after stopping long-term gamma-hydroxybutyrate (GHB) and 8 hours after stopping alcohol intake. He received intravenous fluids and tapering dosages of lorazepam to control agitation and rigidity, and recovered with no significant sequelae after 8 days. Abrupt cessation of GHB after high-dosage abuse can precipitate a clinically significant withdrawal syndrome.

Clozapine-associated extrapyramidal reaction.

Objective: To report a case of extrapyramidal reaction associated with a dosage increase of clozapine.

Case Summary: A 44-year-old white man with a 20-year history of chronic paranoid schizophrenia was admitted to an inpatient psychiatric facility. His prior medications restarted on admission were clozapine 650 mg at bedtime, haloperidol 10 mg at bedtime, clonazepam 2 mg/d, and aspirin 325 mg/d.

Consumer use of St. John's wort: a survey on effectiveness, safety, and tolerability.

Despite its poorly described pharmacology, effectiveness, and safety, use of St. John's wort (SJW) is largely unsupervised and unexplored, and can potentially lead to adverse outcomes. We conducted a telephone survey of 43 subjects who had taken SJW to assess demographics, psychiatric and medical conditions, dosage, duration of use, reason for use, side effects, concomitant drugs, professional consultation, effectiveness, relapse, and withdrawal effects.

Risperidone and hyponatremia: a case report.

A 48 year-old white male not suffering from endocrine disease or polydipsia, not taking diuretics, and suffering from no renal disease was started on risperidone and discharged on no other drug from Western Missiouri Mental Health Center (WMMHC) after an 8-day hospitalization. Seven days later he was admitted to a university medical center with generalized seizures, hyponatremia, respiratory failure, and rhabdomyalysis. He eventually recovered, was transferred back to WMMHC, and stabilized on appropriate medication.

A comparative study of psychotic and nonpsychotic stalking.

A comparative analysis of psychotic versus nonpsychotic stalking is presented. Archival files of 25 forensic subjects whose alleged criminal offenses met a legal definition of stalking behavior were studied for demographic characteristics, stalking dynamics, psychosocial history, and current psychological variables. Although nearly one-third of all subjects had an Axis I psychotic disorder and were delusional, only one of these subjects had erotomanic delusions.

An atypical course of neuroleptic malignant syndrome.

Based on the discussion of NMS, certain conclusions may be reached in regard to this patient. In the psychiatric setting, agitation and confusion alone are not suggestive of NMS. However in this patient, the symptoms of agitation, the rapid development of EPS symptoms unresponsive to anticholinergic therapy, autonomic changes (tachycardia, diaphoresis, and incontinence), and elevated CPK, met most of the diagnostic criteria described in Table VI.

An uncertain future: children of mentally ill parents.

Research reports the uncertain outcome of variables affecting the life of a child of an MI parent. Nurses must avoid stereotyping children before assessment; they are to be in the forefront in assessing self-care skills and deficits to guide planning individual interventions for children and MI parents. Long-term research theory-based interventions will enhance mental health in high-risk children and families.

Drug-use evaluation programs for psychotropic medications.

Drug-use evaluation (DUE) programs for psychotropic medications at a state-operated mental health center are described. DUE programs were developed at Western Missouri Mental Health Center to monitor prescribing of medications in the hospital and ambulatory-care settings. DUE criteria were developed for all major groups of psychotropic medications: antipsychotics, antidepressants, antianxiety and hypnotic agents, lithium, and antiparkinsonian drugs.

Comparison of videocassette and personal instruction methods for training pharmacy personnel in aseptic technique.

A videocassette self-instruction method of aseptic-technique training was compared with a one-on-one instructor-trainee method to determine the effectiveness and cost of each method. Pharmacy department personnel and pharmacy students with no previous training in aseptic technique were randomly assigned to receive either personal or videocassette instruction. The trainees completed an identical set of practice activities.