Manic syndrome after metrizamide myelography.

Depression, anxiety, and delirium have been associated with metrizamide myelography. The authors report a patient who developed an organic affective disorder with manic symptoms several hours after metrizamide myelography.

A survey of consultation-liaison psychiatry program characteristics and functions.

A survey of medical school affiliated consultation-liaison psychiatry programs has provided useful information on several aspects of current C-L program activity, including: (a) patients seen and treatments provided; (b) C-L training; (c) program structure (and fiscal operations); and (d) subjective appraisal by program directors. Data on patients, diagnostic categories, and treatments support the findings of similar, previous studies. Training and research appear to be continuing at past levels rather than increasing. Limited information on fiscal operations and program structure preclude adequate assessment of their strengths and vulnerabilities. Recording of better data and the development of more aggressive management techniques are proposed as appropriate foci of attention for C-L program leaders.

Current concepts of geriatric pain and its treatment.

Because stress and depression are prevalent in the elderly, the opportunity for pain to intensify stress and depression may be greater in older people than in the general population. Evidence that pain-related psychosomatic complaints are more frequent in the elderly further complicates the issue. Antidepressants that affect serotonergic systems may have analgesic properties independent of their antidepressant properties; eg, amitriptyline and doxepin. These drugs may have a more rapid effect on pain than on depression.

Newer antipsychotic drugs and obesity in children and adolescents. How should we assess drug-associated weight gain?

OBJECTIVE: Antipsychotic drugs may contribute to weight gain in children and adolescents. METHOD: We used Medline's PubMed in the pediatric age using key words 'weight gain' and 'obesity', for each newer antipsychotic drug. RESULTS: We found 21 articles linking weight gain and obesity with newer antipsychotic drugs among youths. Risperidone was the most commonly cited agent. Weight gain from olanzapine was the largest among the more commonly prescribed newer agents. All studies reported absolute weight gain. Only a few studies used the better measure of body mass index (BMI). None incorporated growth charts to allow for changes in weight and height over time because of growth. CONCLUSION: Weight gain may be a major problem when prescribing newer antipsychotic drugs in the pediatric population. Risperidone is associated with less weight gain than olanzapine. Published reports and studies have not utilized state-of-the-art techniques using BMI with readily available growth charts.

Challenges and opportunities for consultation-liaison psychiatry in the managed care environment.

While the evolving managed care revolution is dramatically changing the clinical, educational, and economic systems in which consultation-liaison (C-L) psychiatrists must operate, this revolution also present several important opportunities for those in C-L psychiatry. The authors, who are academic department chairs and formerly directed C-L divisions, discuss C-L psychiatry's potential involvement and suggest approaches to effectively address key aspects of these changes.

Psychosis associated with clonazepam therapy for blepharospasm.

A 73-year-old woman with no previous psychiatric history received clonazepam maintenance therapy for essential blepharospasm. Visual, auditory, and tactile hallucinations as well as paranoid delusions were documented. Dose reduction resulted in complete disappearance of the hallucinations and reduction of paranoia to an acceptable level, with no exacerbation during the subsequent 12 months. To our knowledge, this is the first well documented report of psychosis induced by clonazepam. Psychosis was probably related to clonazepam-induced increased central nervous system serotonin and possible predisposition to organic brain syndrome by undocumented causes. Dose reduction is suggested as an alternative to discontinuing the drug when hallucinations or paranoia arise during clonazepam therapy, if no other satisfactory treatment is available and if adequate patient monitoring and protection exist.

The brassiere shop: a front line of assistance to the mastectomy patient.

This report presents information received from a sampling of breast prosthesis fitters which is of importance to surgeons working with mastectomy patients. The characteristics of various types of external prostheses are described. Shop fitters relate their attitudes about patients, describe patients' reactions to cancer and surgery and the problems encountered in proper fitting, and discuss their limitations as counselors. Fitters' negative attitudes toward reconstruction mammaplasty are also presented. The authors discuss these attitudes and raise questions about appropriate interaction between surgeons and prosthesis fitters.

Neuropsychological function following mild exposure to pentaborane.

Neuropsychological tests and self-report personality inventories were administered to 14 workers and rescue squad personnel approximately 2 months following mild exposure to pentaborane, a highly toxic volatile liquid boron hydride. Performance decrements were evident on 5 of 11 neuropsychological tests, including Block Design and measures of sustained attention and recent memory. Neuropsychological deficits were not related to emotional changes reported on the Hopkins Symptom Checklist nor to the presence of CT scan abnormality. These results indicate mild residual brain dysfunction following pentaborane intoxication, including possible dysfunction in subcortical regions mediating memory processes and in cortical areas mediating visuo-spatial abilities.

The validity of psychiatric diagnosis under conditions of physical trauma: a pilot study.

The validity of psychiatric diagnosis obtained from hospitalized trauma patients was investigated to determine whether hospitalization with associated pain, discomfort, and medication artificially inflated the estimated prevalence of psychiatric diagnoses. Diagnostic Interview Schedule results from eleven hospitalized patients were compared with those obtained from the same patients after discharge. Diagnoses were found to be consistent for eight of eleven patients and eleven of fifteen diagnoses remained unchanged. This study yielded no evidence that recent trauma and hospitalization significantly influenced the initial psychiatric diagnoses obtained using the DIS.

Surgical staff recognition of psychopathology in trauma patients.

This study investigated the recognition of psychopathology by the surgical team in 56 trauma patients independently evaluated by the authors for current psychiatric diagnosis using research criteria. Thirty-four per cent of patients (N = 19) met criteria for one or more psychiatric disorder, with alcohol abuse/dependence the most frequent diagnosis (N = 16). Examination of medical records showed no mention of psychopathology or related treatment plan for 13 of 19 patients (68%). Three patients' charts had brief comments related to the psychopathologic diagnosis, and three charts documented requested psychiatric consultation. This study demonstrates that substantial treatable psychopathology was undocumented and untreated in a trauma surgery patient population.

Psychopathology in medical inpatients and its relationship to length of hospital stay: a pilot study.

A composite screening instrument measuring depression, anxiety, cognitive dysfunction, and pain identified 40 percent of a sample of general medical inpatients (30% of total patients before exclusions) as having significant psychopathology or pain, a reasonable number based on clinical incidence literature. These identified patients' hospital length of stay did not differ from the length of stay for other patients. The screen identified 21 percent as very depressed, 19 percent as very anxious, 15 percent as having cognitive dysfunction, and 11 percent with high pain levels. Depression, anxiety, and pain frequently occurred together. Further study is required to refine the instrument and assess its effectiveness at targeting patients for psychiatric intervention.

Patient and direct-care staff body mass index in a state mental hospital: implications for management.

OBJECTIVE: Obesity is a major problem among chronically psychotic patients. METHOD: We assessed body mass index (BMI) of chronically psychotic patients on admission to a state mental hospital and in follow-up. We also compared patient BMI to staff BMI. RESULTS: The initial patient BMI (26.4 +/- 5.8 kg/m2) was in the overweight range. The patient BMI (29.1 +/- 5.8 kg/m2) increased (P < 0.0001) on follow-up and almost reached the level of obesity. Staff BMI (35.1 +/- 8.6 kg/m2) was in the obese range with 64.9% meeting criteria of obesity and 29.9% meeting criteria of morbid obesity. African-American women made up 84.5% of clinical-care staff and constitute the race-sex mix most vulnerable to obesity in the US. Morbid obesity (BMI > or = 40 kg/m2) was five times more common among these African-American female clinical-care staff than among African-American women in the general US population. CONCLUSION: Our findings may have treatment implications for chronically psychotic patients at risk for obesity.

Posttraumatic stress disorder from pentaborane intoxication. Neuropsychiatric evaluation and short-term follow-up.

Fourteen individuals briefly exposed to a toxic industrial compound, pentaborane, were evaluated for neuropsychiatric abnormalities four to 12 weeks after exposure. Results of physical, neurological, and routine laboratory evaluations were normal. Initial and persistent psychiatric symptoms, neuropsychological deficits, electroencephalographic changes, elevated central nervous system neurotransmitter levels, and ventricular brain ratios (computed tomographic scan) provide evidence of central nervous system damage. Seven patients met diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, ed 3, for posttraumatic stress disorder, and seven patients had neuropsychological test evidence of mild brain dysfunction. No statistically significant relationship was found between neuropsychiatric test results and psychiatric diagnoses. These results contradict previous literature that reports most symptom resolution within the first week after exposure to pentaborane. Results suggest that patients suffered a combination of organic brain insult and psychological trauma.