Awareness of treatment needs and length of stay amongst psychiatric inpatients.

INTRODUCTION: Inpatient psychiatric units experience significant pressure from third party payers to keep length of stay (LOS) to a minimum despite having to treat more severely ill patients. However, there is a paucity of empiric data for guiding treatment decisions that maximize therapeutic outcome while minimizing LOS. We therefore endeavored to begin utilizing a newly created psychometric instrument that assesses patient psychological factors, which we propose will allow for LOS prediction and individualization of therapeutic outcome. MATERIALS AND METHODS: The Goals Questionnaire (GQ), created to determine awareness of treatment needs, was administered to newly admitted patients. Linear regression analyses were conducted to ascertain the relationship between the GQ score and LOS, as well as the effects of confounding factors. RESULTS: A significant and inverse relationship was found between the GQ score and LOS (ß=-4.4; p=0.007) that was dependent upon (i.e., had a significant interaction with) age and substance use disorders. There was minimal confounding from common administrative, legal, and clinical factors. CONCLUSIONS: The GQ may have utility for inpatient treatment teams, providing information that can be used to maximize and individualize therapeutic outcome while minimizing LOS.

Standard renal replacement therapy combined with hemoadsorption in the treatment of critically ill septic patients.

The aim of the study was to assess clinical and paraclinical effects of hemoadsorption on organ dysfunction, severity scores, and 28-day survival in septic patients. Fifty-five septic patients admitted to a general intensive care unit of a university hospital were included in the present study. Each patient underwent three consecutive 24-hour sessions of renal replacement therapy in combination with hemoadsorption. Clinical and paraclinical variables were measured after the treatment and severity scores were calculated. The use of hemoadsorption was associated with an increase in arterial partial pressure of oxygen/fraction of inspired oxygen ratio (P = .02), urine output (P = .01), and Glasgow Coma Score (P = .03) and a decrease in white blood cell count (P = .03), C-reactive protein (P = .01), procalcitonin (P = .01) levels, and platelet count (P = .01). The use of hemoadsorption was associated with an improvement in neurological and renal functions and a decrease in inflammatory markers. Acute respiratory distress syndrome improved significantly based on relevant improvements in one-third of the patients.

Oxcarbazepine in the treatment of child psychiatric disorders: a retrospective chart review.

Though not considered a first-line treatment, oxcarbazepine has become an option in the expanding effort to ameliorate severely dysregulated mood and behavioral symptoms in youth. Like most pharmaceuticals in child and adolescent psychiatry, oxcarbazepine is not U.S. Food and Drug Administration (FDA)-approved for the treatment of psychiatric disorders. A search of the world literature found a single case report pertaining to this topic. This paper is a chart review of 14 children and adolescents treated with oxcarbazepine who presented with moderate to severe problems with anger and irritability associated with a range of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses. A majority (70%) of patients was treatment-resistant to prior psychopharmacologic efforts, and 70% were receiving combined treatment with other agents in addition to oxcarbazepine. Moderate clinical global improvement was reported in 50% of patients receiving oxcarbazepine; tolerability was good in 86%.

An open-label study of adjunctive modafinil in patients with sedation related to serotonergic antidepressant therapy.

OBJECTIVE: In patients with major depressive disorder (MDD), excessive sleepiness and fatigue not only are major components of the disorder, but also may occur as side effects of antidepressant therapy. In addition, sedation may be a consequence of antidepressant regimens. The novel wake-promoting agent modafinil improves wakefulness and reduces fatigue across a variety of clinical disorders. This study assessed the use of modafinil as an adjunctive treatment in patients with MDD who reported sedation related to serotonergic antidepressant therapy. METHOD: Data were collected between September 2001 and December 2003. Twenty men and women with DSM-IV-defined MDD were enrolled in this 3-week, open-label, single-center study. In addition to ongoing and stable treatment with selective serotonin reuptake inhibitors (SSRIs), clinic patients received modafinil once daily. Efficacy assessments were conducted at 1-week intervals. RESULTS: Sixteen patients (80%) completed the study. Modafinil plus SSRIs significantly improved overall depressive symptoms, as shown by reductions in mean Hamilton Rating Scale for Depression total scores (p <.001 vs. baseline). Adjunctive modafinil significantly improved subjective estimates of wakefulness on the Epworth Sleepiness Scale (p <.001, all weeks) and reduced fatigue on the Fatigue Severity Scale (p =.009). At the final visit, modafinil had improved overall health status and health-related quality of life, as shown by significant improvements in mean Medical Outcomes Study Short-Form 12-Item Health Survey total scores (p =.007) and in physical health (p =.04) and mental health (p =.006) subscores. CONCLUSION: In patients with MDD who experience sedation as a side effect of antidepressant therapy, adjunctive modafinil improved wakefulness and reduced fatigue. Modafinil plus SSRIs also improved mood and quality of life.

An open-label study of tiagabine as augmentation therapy for anxiety.

BACKGROUND: At least 50% of patients with anxiety disorders experience only partial response to pharmacotherapy and require augmentation therapy. Gamma-aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the CNS, and agents that modulate GABA neurotransmission have shown promise in the treatment of anxiety disorders and are often used as augmentation agents. OBJECTIVE: This study evaluated tiagabine, a selective GABA reuptake inhibitor (SGRI), as augmentation therapy. METHODS: This 8-week, open-label study enrolled patients who remained symptomatic despite adequate drug trials for treatment of anxiety symptoms. Tiagabine augmentation therapy was initiated at 4 mg/d (taken in 2 doses; one in the morning with breakfast and one in the evening with a snack) for 2 days and increased to 8 mg/d for 10 days. Dose was then adjusted according to efficacy/tolerability in increments of 2 mg every 3 days up to a maximum of 20 mg/d. Effect was assessed using the Hamilton Rating Scale for Anxiety (HAM-A), Beck Anxiety Inventory (BAI), Clinical Global Impression (CGI) scale, Pittsburgh Sleep Quality Index (PSQI), and 36-item Short-Form Health Survey (SF-36). RESULTS: Of the 18 patients enrolled, 17 were included in the efficacy analysis; one withdrew due to an adverse event prior to post-baseline assessment. Mean final dose of tiagabine was 13 mg/d. Tiagabine as augmentation therapy further reduced anxiety symptoms, as shown by significant decreases in mean HAM-A total and BAI scores at Week 8 (P<0.001). Thirteen patients (76%) responded (> or =50% reduction in HAM-A total score), and 10 patients (59%) achieved remission (HAM-A total score < or =7) at Week 8. Tiagabine improved sleep quality, with a significant reduction seen in PSQI global score at Week 8 (P=.001). Augmentation therapy with tiagabine was generally well tolerated. CONCLUSION: These preliminary findings suggest that the SGRI tiagabine may be an effective and generally well tolerated augmentation therapy in patients with anxiety who remain symptomatic despite adequate drug trials for treatment of anxiety symptoms.