摘要:

A number of studies have investigated the outlook for patients who present soon after a first-ever single, unprovoked epileptic seizure. Such seizures are usually of a bilateral tonic-clonic nature. It has been demonstrated that further attacks occur in 40 to 50% of individuals who are not subsequently treated with anticonvulsants, most of the recurrences occurring within 6 months of the initial seizure. The risk of recurrence is higher if the initial seizure is a partial one, if abnormal neurological findings are present, or if the EEG is abnormal. Two studies have now shown that the risk of seizure recurrence is more than halved if anticonvulsants are prescribed from the time of presentation after the initial seizure.Therefore, it appears that there is a case for commencing anticonvulsant therapy if a patient is seen in the first few months after a single unprovoked seizure which is of a partial type, or if abnormalities are present on neurological examination, or if the EEG shows paroxysmal activity. Anticonvulsants appropriate for the patient's seizure type should be used.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

摘要:

Delusional misidentification syndromes (DMSs) involve the delusional misidentification of the physical and/or psychological identity of the self or others. DMSs always exist in association with a specific mental disorder.The treatment of DMSs usually follows the treatment of the underlying mental disorder. From an aetiological standpoint. DMSs may be grouped as being associated with either a functional psychosis or a psychotic disorder secondary to a general medical condition. Additionally, associated mood psychopathology is not uncommon.The mainstay of treatment of DMSs involves antipsychotic medication, but various thymoleptics and electroconvulsive therapy (ECT) have an important role in treatment. Supportive psychological therapy can also be an important therapeutic adjunct.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

摘要:

Drug intoxication, acute illness and other stressors can produce delirium, a common complication of hospitalisation in older patients, particularly those with dementia. Because delirium is associated with a high mortality and morbidity, clinicians must recognise it and treat its underlying causes without delay.Drugs are a leading contributor to delirium. Agents commonly linked to delirium include anticholinergic drugs, hypnosedatives, analgesics (opioid and nonopioid), histamine H2receptor antagonists and antiparkinsonian drugs. Drugdrug and drug-disease interactions may also cause delirium in situations when a single drug alone would be well tolerated. For many drugs, it is not known through what mechanism they produce acute mental deterioration. Furthermore, delirium can occur despite ‘therapeutic’ serum concentrations.A major challenge is excluding other medical problems. A cost-effective approach focuses on a basic clinical evaluation searching for the most common aetiologies, such as fluid/electrolyte disturbances, infection and drug toxicity. Specialised testing such as neuroimaging is reserved for selected cases.The key to managing delirium is to treat its underlying cause. If a medication is at fault, eliminating that agent, or substituting a less deliriogenic alternative, is needed. Delirium takes time to abate, so the patient must be kept from harm in the meantime. This includes restorative and supportive care, and control of behaviours that are harmful to the patient or others around them.Pharmacological therapy is often used to manage delirium, but no medication used to treat delirium is entirely safe.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

摘要:

Although &bgr;-adrenoceptor blockers (in particular, propranolol) have been used in the treatment of psychiatric disorders for many years, their indications, extent of efficacy and place in therapy remain unclear. This overview assess the published reports on the use of these drugs in psychiatric disorders.It can be concluded that &bgr;-adrenoceptor blockers may be helpful in the management of some forms of anxiety disorders, including performance anxiety and other types of situational anxiety, especially when somatic symptoms are prominent. In the same way, alcohol (ethanol) withdrawal syndrome of moderate severity, antipsychotic-induced akathisia and lithium-induced tremor seem to be responsive to this drug class. Because of the fact that they are well tolerated, the use of &bgr;-adrenoceptor blockers in these disorders should be considered whenever drug treatment is being contemplated.In contrast, the efficacy of high doses of &bgr;-adrenoceptor blockers in schizophrenia remains unestablished. However, they may be of benefit in some patients presenting with aggressive behaviour due to organic brain disease. Studies have shown a high rate of improvement in this condition, especially in patients who have previously failed to respond to other treatments. Finally, preliminary results suggest that &bgr;-adrenoceptor blockers may be useful as adjunctive medication in the treatment of depression and chronic anxiety, but further investigations are needed in these areas of patient management.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

摘要:

Benzodiazepines have been available for more than 30 years. At the time of their introduction, these drugs were heralded as a safe alternative to the widely prescribed and addictive barbiturates, and were greeted warmly by the medical profession and by patients. However, the addictive potential of benzodiazepines has been increasingly recognised, placing growing pressure on prescribers and patients to limit their use, especially in the long term.These precautions seem to have been effective, in that prescribing has decreased and the eruption of problems arising from addiction among patients on prescribed drugs appears to have passed its peak. On the other hand, benzodiazepines have been taken up by street drug abusers, not only at conventional doses and by the oral route, but also in larger doses and intravenously.Alarming new reports from several continents indicate a serious abuse problem, with major attendant risks in terms of mortality and morbidity in the future. Our understanding of the effects of large doses of benzodiazepines administered by the intravenous or oral route is extremely limited, and further clinical research into the physical, psychological and sociological implications of benzodiazepine abuse needs to be undertaken.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

摘要:

▴ Tandospirone is a new addition to the azapirone class of anxiolytics, which may be useful for the long term treatment of anxiety and depressive neuroses.▴ It is a serotonin (5-hydroxytryptamine; 5-HT)1Areceptor agonist that has anxiolytic effects.▴ Unlike benzodiazepines. the anxiolytic and anti-depressant effects of tandospirone can be separated from the sedative, anticonvulsant and muscle relaxant effects.▴ The abuse potential of tandospirone appears to be lower than that of benzodiazepines.▴ Tandospirone has anxiolytic effects similar to those of diazepam in patients with various different neuroses.

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS

ISSN:1172-7047    

出版商:ADIS    

年代:1996

数据来源: ADIS