Reports of corticosteroid‐induced psychiatric effects began to appear in the literature soon after the introduction of these medications in the 1950s. Here, the authors present the case of a man who developed psychosis after receiving high‐dose corticosteroid for rheumatoid arthritis. The complex management of his long‐lasting and challenging symptoms is discussed.
Road safety audits (RSAs) are emerging as an effective tool for proactively improving the safety performance of a road project while it is still in the design or planning stage or for identifying and mitigating safety concerns in existing transportation infrastructure. The authors are nearing the end of a yearlong series of nine pilot RSAs conducted across the United States, sponsored by FHWA's Office of Safety Design and conducted for a variety of agencies at the local (county, city, and tribal) and state levels. The purpose of this paper is to inform the transportation community of this pilot RSA series, to discuss six important lessons learned in the process of conducting the pilot audits, and, on the basis of these lessons, to advise how the usefulness and effectiveness of a road safety audit can be maximized.
AimsTo assess physical health in patients under the Early Intervention Service, whom are prescribed antipsychotics.To consider whether further intervention needs to be provided or promoted to improve physical health in this group.MethodAssessment of carenotes database for all 63 patients on EIS caseload prescribed antipsychotics.ResultOut of 47 patients studied, 20 were non-smokers at baseline. 25% of them ended up becoming smokers by the end of the study time.Out of 47 patients studied 28 were non-drinkers at baseline. 32% of them ended up engaging in alcohol by the end of the study time.Out of 47 patients studied, 38 patients had data available to record weight changes per year. Out of the 38 patients, 27 of them had positive weight change; average weight change was + 6.38 kg per year. The highest weight gain was 38.4 kg, the highest weight lost was 47.3 kg.Out of 47 patients studied, 35 patients had data available to record BMI changes. Out of the 35 patients, 27 of them had positive BMI increases, average BMI change was + 2.68. The highest BMI increase was 12.84. The highest BMI decrease was 8.24.Out of 47 patients studied, 11 patients had data available to record random glucose level changes. Out of the 11 patients, 7 of them had increased glucose levels, average glucose change were + 0.5mmol/l. The highest increase in glucose was 3.9mmol/l and the highest drop in glucose was 2.6mmol/l.Out of 47 patients studied, 19 patients had data available to record HbA1c levels. Out of the 19 patients, 10 of them had increased HbA1c levels, with the average change being + 0.31 mmol/mol. The highest increase in HbA1c levels was 5 mmol/mol and the highest drop in HbA1c levels was 3 mmol/mol.Out of 47 patients studied, 30 patients had data available to record cholesterol changes. Out of the 30 patients, 21 of them had increased cholesterol levels, with the average change being + 0.09mmol/l. The highest increase in cholesterol was 1.7mmol/l and the highest drop in cholesterol levels was 2.6.Taken together, we show that anti-psychotic use has a negative effect on physical health parameters such as weight gain, BMI increase, HbA1c levels and cholesterol levels. This increases the patient's risk of developing diabetes/metabolic syndrome in the future.ConclusionRe-audit.
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