Medical Update for Psychiatrists最新文献

{"title":"Summary of American academy of clinical toxicology and european association of poison centres and clinical toxicologists position: Statements on gut decontamination","authors":"PharmD Edward P. Krenzelok (Past-President),&nbsp;MD J. Allister Vale (Past-President)","doi":"10.1016/S1082-7579(98)00035-1","DOIUrl":"10.1016/S1082-7579(98)00035-1","url":null,"abstract":"<div><p>The Position Statements on gastrointestinal decontamination were produced by the American Academy of Clinical Toxicology and the European Association over a 4-year period using agreed methodology. The Statements conclude that as the effect of syrup of ipecac diminishes with time and as there are no clinical studies to prove that ipecac improves the outcome of poisoned patients, its routine administration in the Emergency Department should be abandoned. It should be considered only if it can be administered within 60 minutes of drug ingestion to an alert conscious patient who has ingested a potentially toxic amount of a poison; even then clinical benefit has not been confirmed in controlled studies. Gastric lavage should not be employed routinely in the management of poisoned patients. There is no certain evidence that its use improves clinical outcome and it may cause significant morbidity. Gastric lavage should not be considered unless a patient has ingested a potentially life-threatening amount of a poison and the procedure can be undertaken within 60 minutes of ingestion; even then clinical benefit has not been confirmed in control studies. Single-dose activated charcoal should not be administered routinely in the management of poisoned patients. On the basis of volunteer studies, the effectiveness of activated charcoal decreases with time; the greatest benefit is within 1 hour. The administration of activated charcoal may be considered if a patient has ingested a potentially toxic amount of a poison (which is known to be adsorbed to charcoal) up to 1 hour previously; there are insufficient data to support or exclude its use after 1 hour. There is no evidence that the administration of activated charcoal improves clinical outcome. On the basis of available data there are no definite indications for the use of cathartics in the management of the poisoned patient. In addition, there are no established indications for the use of whole bowel irrigation. On the basis of experimental studies, WBI is an option for potentially toxic ingestions of sustained release or enteric-coated drugs. WBI is of theoretical value in the management of patients who have ingested substantial amounts of iron and for the removal of ingested packets of elicit drugs.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 6","pages":"Pages 187-195"},"PeriodicalIF":0.0,"publicationDate":"1998-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(98)00035-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76664205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aphasia","authors":"Randolph S. Marshall MD ,&nbsp;Ronald M. Lazar PhD ,&nbsp;J.P. Mohr MD","doi":"10.1016/S1082-7579(98)00026-0","DOIUrl":"https://doi.org/10.1016/S1082-7579(98)00026-0","url":null,"abstract":"<div><p>Aphasia is an acquired disorder of language resulting from focal or diffuse injury to the dominant cerebral hemisphere. Investigation of aphasia provides insight into the complex organization of higher cerebral function. Major motor aphasia is characterized by effortful, dysfluent speech with relatively spared comprehension and is localizable primarily to anterior cortical structures. By contrast, aphasia that produces predominantly sensory features is manifested by fluent, often nonsensical speech littered with paraphasic errors and is characterized by poor comprehension. Major sensory aphasias are localized primarily to posterior parietal and temporal regions of the brain. The minor aphasic syndromes such as conduction aphasia and the transcortical aphasias are produced by anatomically more variable lesions and often appear in the setting of recovery of the major aphasias. In this article, the salient features of all the aphasic syndromes are described in anatomical and clinical detail with reference to groundwork historical observations as well as the modern imaging techniques that have futher advanced our understanding of acquired language dysfunction.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 5","pages":"Pages 132-138"},"PeriodicalIF":0.0,"publicationDate":"1998-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(98)00026-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137008757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychiatric aspects of mercury poisoning1","authors":"Peter A. Stier MD ,&nbsp;Robert A. Gordon (PharmD)","doi":"10.1016/S1082-7579(98)00022-3","DOIUrl":"10.1016/S1082-7579(98)00022-3","url":null,"abstract":"<div><p>Mercury poisoning (although relatively rare) is still a concern for the psychiatrists. Neuropsychiatric manifestations include irritability, emotionational instability and an asthenic vegetative syndrome (erethism). With specific laboratory tests becoming more available and chelation becoming easier to accomplish, this entity should be considered in selected patients.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 5","pages":"Pages 144-147"},"PeriodicalIF":0.0,"publicationDate":"1998-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(98)00022-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87711722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When the patient’s chief complaint is sexual disinterest1","authors":"Domeena C. Renshaw MD","doi":"10.1016/S1082-7579(98)00018-1","DOIUrl":"10.1016/S1082-7579(98)00018-1","url":null,"abstract":"<div><p><span>Sexual desire disorders or disinterest have always existed and have surfaced with increasing frequency in the 1990s in psychiatric practice due to 1) classification as a diagnostic criteria in 1987 (302.71) and 2) widespread use of SSRI antidepressants. Possible physical, chemical or endocrine causes must always be considered and treated </span><span>(1)</span>. Then possible intra- or interpersonal factors as cause or effect as outlined can be addressed. Sexual disinterest is a common psychosomatic symptom that is highly treatable with brief supportive intervention.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 5","pages":"Pages 159-164"},"PeriodicalIF":0.0,"publicationDate":"1998-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(98)00018-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90483457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of neuropsychological testing in neurological disease","authors":"Diane M Jacobs PhD","doi":"10.1016/S1082-7579(98)00030-2","DOIUrl":"10.1016/S1082-7579(98)00030-2","url":null,"abstract":"<div><p>Neuropsychological assessment is an important tool for evaluating cognitive function in patients with neurologic and psychiatric disease. It provides a standardized and reliable quantitative assessment of cognitive strengths and limitations. Level of cognitive functioning is determined relative to peer-referenced normative data and patterns of relative capabilities and limitations are examined. Neuropsychological testing is particularly useful in detecting subtle cognitive dysfunction and documenting change over time.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 5","pages":"Pages 139-143"},"PeriodicalIF":0.0,"publicationDate":"1998-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(98)00030-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75271115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New diagnostic tests for gonorrhea and chlamydia","authors":"Gregory J. Locksmith MD","doi":"10.1016/S1082-7579(98)00021-1","DOIUrl":"10.1016/S1082-7579(98)00021-1","url":null,"abstract":"<div><p><span>Genitourinary infections caused by </span><span><em>Neisseria gonorrhoeae</em></span> and <span><em>Chlamydia trachomatis</em></span> pose significant public health problems in this country. Our ability to effectively screen for, and prevent the spread of, these organisms depends on the availability of accurate and efficient detection methods.</p><p>Culture has been the traditional reference standard for both organisms and has the advantage of 100% specificity. Gonorrhea<span> culture is very inexpensive, while chlamydia<span> culture is moderately expensive. The disadvantages of culture include variable sensitivity, complex logistics, and slow turnaround times. Antigen detection methods, such as direct fluorescent antibody testing and enzyme immunoassay, have fast turnaround times and simplified logistics but lower sensitivity than culture.</span></span></p><p><span>Recently developed tests using nucleic acid<span> technology offer the potential for improved sensitivity, ease of handling, and rapid processing at costs comparable to, or less than, antigen detection methods. Hybridization techniques utilize fluorescent DNA probes which bind directly to species-specific ribosomal RNA. The </span></span>polymerase chain reaction<span><span> (PCR) and ligase chain reaction (LCR) amplify species-specific </span>DNA sequences before detection. The hybridization techniques are the least expensive and appear to have similar accuracy to PCR and LCR. Polymerase chain reaction and LCR may be performed on urine and vaginal swab samples which are easier to collect and may provide a greater yield of organisms. Urine and vaginal samples typically contain organisms inhabiting both the urethra and endocervix, while endocervical specimens do not contain organisms in women who are colonized solely in the urethra. Endogenous inhibitors limit the sensitivity of the amplification techniques. If their effect could be eliminated, PCR and LCR would provide clear clinical advantages over any of the other methods in use.</span></p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 5","pages":"Pages 153-158"},"PeriodicalIF":0.0,"publicationDate":"1998-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(98)00021-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75726778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Otitis media: an update","authors":"Ihuoma U Eneli MD","doi":"10.1016/S1082-7579(98)00019-3","DOIUrl":"10.1016/S1082-7579(98)00019-3","url":null,"abstract":"<div><p><span>Otitis media is a multifactorial disease involving microbiological agents, environmental risk factors and host characteristics. It is a highly prevalent childhood illness. The clinical presentation is typically not specific in younger children and the diagnosis is based on characteristics of the </span>tympanic membrane<span><span>, particularly mobility. The mainstay of management continues to be antibiotics, however, bacterial resistance to antimicrobial agents has influenced the pharmacological management of otitis media. </span>Myringotomies<span> and tympanostomy tube placement are indicated for specific cases of otitis media. Modification of environmental risk factors whenever possible is helpful. Further investigation of microbiological, immunological and genetic influences on this common childhood illness may play a role in shaping our management of otitis media in the next decade.</span></span></p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 5","pages":"Pages 165-169"},"PeriodicalIF":0.0,"publicationDate":"1998-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(98)00019-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73616014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ischemic heart disease","authors":"Steven Kick MD, MSPH","doi":"10.1016/S1082-7579(98)00020-X","DOIUrl":"10.1016/S1082-7579(98)00020-X","url":null,"abstract":"<div><p>Ischemic Heart Disease (IHD) is the single most important preventable disease in the U.S. Risk factors for the development of IHD have been well described, and treatment strategies for the primary, secondary, and tertiary prevention of this disease are available. Because of the prevalence of IHD, and known benefits of intervention, psychiatrists should be familiar with screening and treatment. This paper describes the screening and intervention strategies suitable for psychiatrists caring for patients at risk for IHD.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 5","pages":"Pages 148-152"},"PeriodicalIF":0.0,"publicationDate":"1998-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(98)00020-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82558122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression in the Post-Myocardial Infarction Patient","authors":"Bradford Felker MD ,&nbsp;Molly Shores MD ,&nbsp;Karen Gibbon R Ph","doi":"10.1016/S1082-7579(98)00015-6","DOIUrl":"https://doi.org/10.1016/S1082-7579(98)00015-6","url":null,"abstract":"<div><p><span><span>Depression in the patient who has recently suffered a myocardial infarction is common, with an estimated prevalence of 20%. However, despite this high prevalence, depression in the post-myocardia infarction patient is poorly diagnosed and treated. In addition, depression in these patients has been associated with increased cardiac morbidity and mortality as well as increased disability and health care cost. The pathophysiology relating these two conditions remains unclear but may be related to </span>autonomic dysfunction<span><span> and enhanced risk of arrhythmias. Few well-designed trials have evaluated treatment options for these patients, although several large trials are underway. Of the antidepressant medications available, they all have potential interactions with the </span>cardiac system. However, the </span></span>serotonin selective reuptake inhibitors seem to be emerging as the best first line treatment option for these patients.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"3 4","pages":"Pages 126-130"},"PeriodicalIF":0.0,"publicationDate":"1998-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(98)00015-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91722693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eradication of Helicobacter Pylori","authors":"J. Worrel","doi":"10.1016/S1082-7579(98)00012-0","DOIUrl":"https://doi.org/10.1016/S1082-7579(98)00012-0","url":null,"abstract":"","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"58 5 1","pages":"99-104"},"PeriodicalIF":0.0,"publicationDate":"1998-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79568734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}