IntroductionThere is a growing concern about the potential risk that the use of certain antipsychotics may have on the QTc prolongation, electrocardiographic parameter key to assess the potential risk of developing a potentially lethal ventricular tachyarrhythmia:“Torsade de Pointes”. Previous studies highlights the existence of low levels of potassium in severely agitated patients versus moderately agitated ones (1). So if we take into account that seriously agitated patients tend to receive higher antipsychotic doses, and mainly antipsychotic with a more sedative profile, we face a hotbed for causing a potentially lethal tachyarrhythmia.AimsEvaluate the presence of hypokalemia in agitated psychiatric patients.MethodsWe chose a random sample of 31 agitated psychotic patients attending emergency room and we make a determination of potassium level at that time, compared to a sample of 33 others randomly as control who donate their blood in the hospital blood bank group. Final results, showed that agitated patients presented potassium figures significantly lower than the control group. (3.88 average in agitated versus 4.14 control group), (p = 0,048).ConclusionsThese data confirm our hypothesis of work and the relationship between hypokalemia and psychomotor agitation in psychotic patients attending the emergency ward, increasing notably the risk for “Torsade de Pointes”.
Introduction:Ramón y Cajal Hospital is the reference hospital for area 4 (Madrid), which covers a population of more than 540.000 people. The psychiatric emergencies are one of the most frequent demands at the Emergency Department (ER)Objectives:•Analysis of the cause of psychiatric demand and how it is made: who asks for help and who sends the patient to the hospital.•Analysis of the syndromic diagnosis, derivation and therapeutical attitude at discharge.Material and methods:With data from sample of 145 patients attended by the emergency psychiatry staff between the 15th - 30th August 2008, we performed a descriptive analysis using SSPS 15.0 version in SpanishResults:•Most common reason of consultation was nervousness (22%), being the patient the one who demanded evaluation (31,5%). Less commonly, the patient was sent from the local Mental Health Center (1,37%). Patients usually come accompanied by relatives (41%).•The most frequent syndromic diagnosis at discharge was “affective disorder” (23%),being usually derived to the local Mental Health Center (54%). Modifying the previous treatment after the consultation (37%) was nearly as frequent as leaving the previous one (35%).Starting a new treatment after consultation at the ER was rare (14%).Conclusion:The profile of the patient attended by the psychiatry staff on duty in our hospital, is a patient who demands psychiatric evaluation, comes accompanied by relatives, consults for nervousness, is discharged with a diagnosis included in the spectrum of “affective disorders”, and is derived to the local Mental Health Center.
We have administered a dosage of 120 mg a day of duloxetine to 11 patients diagnosed with melancholy. On these patients, we studied sociodemographical and clinical variables, previous episodes and records, former response to treatment and adherence. They were evaluated at the beginning and then 15, 30, 60, 90 and 120 days after commencing the treatment. The therapeutical response was measured using the Hamilton scale for depression (HDRS). Other items observed were the side-effects and adherence. As an additional medication we used benzodiacepines (anxiolytics and hypnotics). The group's average at the HDRS was 46 points.After 30 days there was an improvement on 9 patients (82%), with a HDRS average score of 30 points. After 90 days there was an improvement on 10 patients (91%), and the HRDS average score was 14. After 120 days the HRDS average score of those 10 patients was 8 points.One of the patients had no response and the treatment had to be reinforced. Only two of them had side-effects, like nausea, constipation, tremulousness and restlessness. We believe that duloxetine is one of the first choices as a treatment for melancholy.
We worked with a group of 36 patients diagnosed with schizophrenia (DSM-IV-TR) who were in a chronic condition, with a predominance of negative and depressive-amotivational sympthomatology. They were on a long-term therapy with antipsychotic agents, achieving just a light improvement on the symptoms.We switched to aripiprazole using a daily dosage of 15-30 mg. We evaluated the results on PANSS and ICG scales at the beginning of the treatment and after the first and third month, whilst paying special attention to the side-effects and adverse reactions that occurred. Concomitantly, we used benzodiacepines and hypnotics during the first two weeks, and antipakinsonism agents were not needed.From an average initial PANSS score of 74 and ICG score of 3.6, after a month, PANSS average score lowered to 60 and ICG's came down to 3. After 3 months, PANSS average score was 45 and ICG'S was 2.5.There was no need for discontinuing the treatment in 35 of the patients. One patient discontinued treatment and follow-up. Side-effects were Invaluable in general, though at the start insomia and light jitterness were observed in some of the patients.We believe that aripiprazole is a very useful antipsychotic drug, not only for controlling acute episodes, but also on chronic patients for its effectiveness and good tolerability.
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