Psychotropic Drugs: Brain and Plasma Pharmacokinetics and the Therapeutic Window
May 1st 2006Administering drug dosages that are clinically effective while causing minimal side effects is a challenge for physicians. The latest data on antipsychotics, antidepressants, and other psychotropic drugs in relation to brain occupancy and plasma levels are reviewed here.
Psychopharmacologic Therapy in Pregnancy: Effects on Newborns
May 1st 2006There is a tendency to avoid psychiatric medications during pregnancy, but the high prevalence of psychiatric disorders in pregnant women means that women and their physicians must make impromptu decisions regarding the initiation or continuation of drug therapy.
TREATING YOUNG PATIENTS AFTER SELF-HARM
May 1st 2006This study examined national patterns in emergency department (ED) treatment of patients aged 7 to 22 years who were seen after episodes of deliberate self-harm. Data were from the 1997-2002 National Hospital Ambulatory Medical Care Survey. Population data from the 2000 US Census Bureau were used to estimate population visit rates for the age group studied.
Informed Consent and Civil Commitment in Emergency Psychiatry
May 1st 2006Medical school graduation usually involves the Hippocratic Oath, in which physicians vow not to intentionally harm their patients. Keeping patients safe is another basic principle of patient care. Physicians are charged with ensuring that their patients are in a safe environment and minimizing risks to their patients by carefully selecting treatment options. In emergency psychiatric settings, patient safety is critical, especially when the patient is a danger to himself or herself or to others.
Involuntary Treatment and the Use of Jails to Treat the Mentally Ill
May 1st 2006All physicians need to be aware of the medicolegal aspects of practicing medicine, but because emergency psychiatrists must sometimes treat patients against their will or act as consultants to determine capacity, they must be especially vigilant when dealing with the overlap between law and medicine.
DETERMINING DECISIONAL CAPACITY INFORMED CONSENT
May 1st 2006Assessing a patient's capacity to make a decision about accepting or refusing a medical intervention should be performed quickly but systematically. Physicians from the department of psychiatry at the Mayo Clinic in Rochester, Minn, present a 3-dimensional model for evaluating capacity. This model includes the risk of the proposed treatment (high vs low), the benefit level of the treatment (high vs low), and the patient's decision about the treatment (accept vs refuse).
What role do psychiatric advance directives have in today's emergency departments?
May 1st 2006Psychiatric advance directives (PADs) allow persons to authorize proxy decision makers and document advance instructions or preferences about future mental health treatment in the event of a crisis. The intent of PAD legislation is to enhance treatment autonomy for persons with severe mental illnesses (such as schizophrenia, bipolar disorder, and major depression) who anticipate periods of decisional incapacity associated with illness relapse.
Gender Differences, Gamma Phase Synchrony and Schizophrenia
April 24th 2006The authors discuss gender differences found in patients with schizophrenia. Their group is the first to explore the possibility that gender differences in schizophrenia are mediated by differences in integrative network activity, reflected in a synchronous phase of high frequency (40 Hz) gamma activity.
"Chemical Imbalance": Oversimplification or Metaphor?
April 5th 2006Until recently, direct-to-consumer advertisements for selective serotonin reuptake inhibitors (SSRIs) touted their ability to correct a chemical imbalance, most memorably through the cartoon "ovoid creature" that thanked a drug for improving its mood. Over the past few years, consumer groups and patients have implored the FDA to require more accurate wording in ads. This has resulted in the appearance in ads of such qualifiers as "helps to restore," "appears to work," "may be related to," and "presumed to be linked."