Beginning in 1990, the Department of Psychiatry. Tripler Army Medical Center developed a formal treatment program for post-traumatic stress disorder (PTSD). Between 1990 and 1996, 632 patients, the vast majority of whom suffered from combat-related PTSD, were treated. Historically, many PTSD patients were treated with benzodiazepines, often in high dosages. The risks attendant to benzodiazepine management of PTSD, coupled with poor clinical outcome, prompted the staff to explore treatment alternatives. This paper describes the role of pharmacotherapy in the management of PTSD. The medications described in this paper have other primary uses in clinical practice (e.g., hypertension, insomnia, seizure control, depression, and anxiety). Medications were selected for use based on the putative modes of action and the degree of symptom relief. The therapeutic rationale was to decrease hyperarousal and sleep disturbance to permit the patients to engage in other psychotherapeutic efforts.
Due to the worldwide mission of the military, service members often find themselves isolated from their families and other important people in their lives. Historically, this has been especially problematic during periods of illness, as the isolation has precluded the meaningful involvement of families in patient care. With the increased availability of real-time video teleconferences (VTCs), however, providers may now gain access to family members. The Inpatient Psychiatry Department at Tripler has conducted therapeutic trials of family meetings using real time VTCs. These meetings are used to facilitate social support and mend family disconnections. The high clarity images offered through this system were instrumental in developing a virtual interactive social presence among the participants. Despite the potential benefits of VTC in gaining accessing to family support, there is little mention of such clinical family meetings in the medical literature. This report describes two case examples of the application of real-time family VTC in the management of mental illness.
Introduction: Among recreational drug users, there is a new wave of designer drugs being marketed as "bath salts" and "plant food," which mimic the effects of cocaine/amphetamines and ecstasy (MDMA [3,). Presented is the case of a patient who snorted a bath salt called Cristalius. Case presentation: A 22-year-old male Soldier was seen in an emergency department for syncope, agitation, confusion, and tachycardia. He reported snorting 1 g of Cristalius the night before. Significant labs included a creatine kinase of 668 U/L, serum creatinine of 1.35 mg/dL, and troponin of 0.516 ng/mL. His abnormal labs trended to normal and a computed tomography coronary angiogram was unremarkable. Discussion: The main ingredients postulated in these products are mephedrone and a synthetic cathinone derivatives of the khat plant. The intended effects include euphoria, empathic connection, mood enhancement, increased sensory perception, with decreased inhibition. Unwanted sympathomimetic side effects include hypertension, tachycardia, chest pain, diaphoresis, dilated pupils, seizures, bruxism, and headaches. Neuropsychiatric symptoms include agitation, anxiety, paranoia, tremors, and insomnia. Conclusion: No treatment guidelines currently exist for mephedrone or MDPV (3,4-methylenedioxypyrovalerone) toxicity. If suspected, ensure adequate cardiac evaluation is completed regardless of age. Appropriate supportive care and addressing any complications is the primary treatment.
Alcohol Use Disorders are thought to be underdiagnosed in the geriatric population. A retrospective medical record review was performed on 383 patients who presented for outpatient geriatric assessment from 1985-1990. The record review included data on the alcohol consumption history, age, sex, presence of alcoholic beverages in the home, geriatric psychiatry evaluation, and alcohol-related diagnoses. Alcohol Use Disorders were recognized as contributing to medical problems in 10% of patients having a mean age of 78 years. All except one patient were found to be cognitively impaired. In addition, 9% of patients consumed alcohol on a regular basis and this consumption was not considered in the diagnosis, despite the presence of cognitive impairment. Twenty-five percent of cognitively impaired patients were consuming alcohol at the time of evaluation. These results indicate that alcohol consumption and AUD are common in cognitively impaired patients presenting for geriatric assessment. Recognition of Alcohol Use Disorders is essential, as chronic alcohol toxicity represents one cause of potentially reversible dementia. Because there are no validated instruments for alcoholism screening in cognitively impaired elderly patients, evaluation should include a past and present consumption history, a search for alcoholic beverages at the home visit, and possible psychiatric referral.
Lysergic Acid Diethylamide (LSD) is a hallucinogenic drug that received considerable attention in the 1960's and early 1970's. It produced a wide variety of psychological phenomena, including a variety of perceptual disturbances which would manifest among some users long after the drug had left the system. These phenomena were commonly referred to as "flashbacks" and may have been largely responsible for the drug falling out of favor among recreational drug users. This report describes histories of LSD use among alcoholism treatment facility inpatients and reports specific characteristics of flashbacks and the degree of subjective distress experienced during flashbacks. Findings indicate a statistically significant relationship between number of doses and incidence of flashbacks.
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