Phenobarbital is a barbiturate that may be used as an antiepileptic to control partial and generalised tonic-clonic seizures. It is also used as part of the emergency management of acute seizures including status epilepticus. The dose should be adjusted to the needs of the individual patient to achieve adequate control of seizures; this usually requires… Read More »
General guidelines for psychotropic medication use in frail elderly patients are applicable. Systematic evidence to support the effectiveness of particular psychotropic drugs in dementia patients is limited. Therefore, choice of drug class may be based on clinical evidence, and choice of agent is often based on the side-effect profile and on the characteristics of a… Read More »
For a patient who survives a recent suicide attempt, the emergency department usually is the first stop for assessment and triage. If the patient is medically cleared, ideally a psychiatrist, but sometimes another mental health professional, evaluates the patient and decides whether psychiatric inpatient or outpatient management is the appropriate disposition. It is important for… Read More »
Several classes of medications are used in the treatment of insomnia. They include the benzodiazepines, non-benzodiazepine hypnotics, antidepressants, and over-the-counter medications. There are six benzodiazepines that are specifically marketed as hypnotics in the United States or in Canada: flurazepam, temazepam, triazolam, estazolam, quazepam, and (in Canada only) nitrazepam. Several other benzodiazepines (e.g., lorazepam, clonazepam, oxazepam),… Read More »
Benzodiazepine hypnotics can be categorized into three groups based on their pharmacokinetic characteristics: short-acting, intermediate-acting, and long-acting. Short-acting benzodiazepines such as triazolam (Pfizer’s Halcion, generics) generally have elimination half-lives of 6 hours or less; intermediate-acting benzodiazepines such as temazepam (Mallinckrodf s Restoril, generics), oxazepam (Wyeth’s Serax / Serepax, Boehringer-Ingelheim’s Adumbran, generics), and lormetazepam (Wyeth’s Loramet,… Read More »
Psychotherapy An overemphasis on psychopharmacology in the care of medically ill patients may result in overlooking the value of psychotherapy. The first step in the treatment of anxiety is to spend time listening to and talking with the patient. Just as in psychotherapy with any patient, empathic listening is a powerful tool to relieve distress.… Read More »
Question. What is your opinion/experience on using Haldol IM in large doses (100mg. x 3 and 300mg/month for maintenance) for rapid tranquillization? I have been doing this in a prison population with good results, but wonder what risks may be. Answer. If I understand your question correctly, there are really two distinct issues being raised:… Read More »
Bipolar disorder, also called manic-depressive disorder, is a recurrent illness in which the individual’s mood cycles between depression and mania with periods of normality. The illness is a mood disorder. The individual’s moods may swing from manic euphoria, with boundless energy in pursuit of grandiose plans, to depths of depression, with feelings of despair and… Read More »
When assessing the patient, enquiries should be made about their recent compliance with medication, as sudden discontinuation of lithium may have triggered the manic episode. It is usually prudent to cease any antidepressant medication they may have been taking. A physical examination and tests of the blood and urine should, if possible, precede drug treatment… Read More »
To prove that a drug is efficacious in a psychiatric condition, it is essential to show that it is superior to placebo, by conducting randomized double-blind placebo-controlled trials. The challenges of conducting such trials in mania have only been met in recent years, in the course of developing novel anticonvulsant and atypical antipsychotic treatments. These… Read More »