New atypical antipsychotic medications

Jibson, Michael D.; Tandon, Rajiv

doi:10.1016/s0022-3956(98)00023-5

Cited by 193 publications

(98 citation statements)

References 12 publications

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“…Antipsychotic and sedative agents are widely used on inpatient psychiatric units. Antipsychotic agents may cause orthostatic hypotension or sedation, increasing the risk of a fall (27). Also widely used, benzodiazepine agents cause sedation, which also may increase the risk of falling.…”

Section: Discussionmentioning

confidence: 99%

Adverse Events Associated With Organizational Factors of General Hospital Inpatient Psychiatric Care Environments

Hanrahan¹,

Kumar²,

Aiken³

2010

Psychiatric Services

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Objective-Although general hospitals receive nearly 60% of all inpatient psychiatric admissions, little is known about the care environment and related adverse events. The purpose of this study was to determine the occurrence of adverse events and examine the extent to which organizing factors of inpatient psychiatric care environments were associated with the occurrence of these events. The events examined were wrong medication, patient falls with injuries, complaints from patients and families, work-related staff injuries, and verbal abuse directed toward nurses.Methods-This cross-sectional study used data from a 1999 nurse survey linked with hospital data. Nurse surveys from 353 psychiatric registered nurses working in 67 Pennsylvania general hospitals provided information on nurse characteristics, organizational factors, and the occurrence of adverse events. Linear regression models and robust clustering methods at the hospital level were used to study the relationship of organizational factors of psychiatric care environments and adverse event outcomes.Results-Verbal abuse toward registered nurses (79%), complaints (61%), patient falls with injuries (44%), and work-related injuries (39%) were frequent occurrences. Better management skill was associated with fewer patient falls and fewer work-related injuries to staff. In addition, fewer occurrences of staff injuries were associated with better nurse-physician relationship and lower patient-to-nurse staffing ratios.Conclusions-Adverse events are frequent for inpatient psychiatric care in general hospitals, and organizational factors of care environments are associated with adverse event outcomes. Further development of evidence-based quality and safety monitoring of inpatient psychiatric care in general hospitals is imperative.A 1999 landmark report by the Institute of Medicine on the quality of care in general hospitals found high rates of patient injuries and preventable deaths associated with medical errors (1). Since that report, quality management of hospital care environments has become a high national priority, with a large emerging research base showing that organizational factors-such as institutional policies, nurse staffing, and other processes-may inadvertently contribute to worse outcomes and medical errors (2). This research was specific to the medical-surgical sector of general hospitals, and there are comparatively few studies of adverse events for inpatient psychiatric care settings even though inpatient psychiatric services are provided in Correspondence to: Nancy P. Hanrahan, nancyp@nursing.upenn.edu. The authors report no competing interests. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript most general hospitals (3). In our study, organizational features of the general hospital inpatient psychiatric care environment were examined in relation to adverse event outcomes.In the medical-surgical sector of general hospitals, an understanding of quality and safety has guided the development of...

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Section: Discussionmentioning

confidence: 99%

Adverse Events Associated With Organizational Factors of General Hospital Inpatient Psychiatric Care Environments

Hanrahan¹,

Kumar²,

Aiken³

2010

Psychiatric Services

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“…119 The newer antipsychotic agents are found to be moderately more effective than the older antipsychotics in improving cognitive function, 120 which may in part be explained by their lower propensity to cause extrapyramidal side effects and associated lower use of anticholinergic agents. 121,122 However, the overall effects of antipsychotic medications on cognitive functioning are modest.…”

Section: Neuroimaging Studiesmentioning

confidence: 99%

Towards a muscarinic hypothesis of schizophrenia

Raedler

Bymaster

Tandon³

et al. 2006

Mol Psychiatry

244

211

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Although the neurotransmitter dopamine plays a prominent role in the pathogenesis and treatment of schizophrenia, the dopamine hypothesis of schizophrenia fails to explain all aspects of this disorder. It is increasingly evident that the pathology of schizophrenia also involves other neurotransmitter systems. Data from many streams of research including preclinical and clinical pharmacology, treatment studies, post-mortem studies and neuroimaging suggest an important role for the muscarinic cholinergic system in the pathophysiology of schizophrenia. This review will focus on evidence that supports the hypothesis that the muscarinic system is involved in the pathogenesis of schizophrenia and that muscarinic receptors may represent promising novel targets for the treatment of this disorder.

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“…Although pharmacological data implicate increased DA activity in the pathogenesis of positive symptoms of schizophrenia, there is minimal association with negative symptoms (Crow 1980;Andreasen and Olsen 1982;Angrist et al 1980). The poorly elucidated pathogenesis of negative symptoms and the unique properties of the atypical antipsychotic clozapine (Jibson and Tandon 1998) have encouraged a reappraisal of the role of the DA system in schizophrenia. Newer approaches to evaluating neurochemical abnormalities in schizophrenia include consideration of other neurotransmitter systems.…”

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confidence: 99%

The Cholinergic System in Schizophrenia Reconsidered: Anticholinergic Modulation of Sleep and Symptom Profiles

Tandon

Taylor

DeQuardo

et al. 1999

Neuropsychopharmacology

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Receptors, Cholinergic; Receptors, muscarinic; Parasympathetic nervous system; Sleep, REM; Symptoms, positive; Symptoms, negative The dopamine (DA) hypothesis has dominated biochemical and pharmacological research on schizophrenia for about two decades. Although pharmacological data implicate increased DA activity in the pathogenesis of positive symptoms of schizophrenia, there is minimal association with negative symptoms (Crow 1980;Andreasen and Olsen 1982;Angrist et al. 1980). The poorly elucidated pathogenesis of negative symptoms and the unique properties of the atypical antipsychotic clozapine (Jibson and Tandon 1998) have encouraged a reappraisal of the role of the DA system in schizophrenia. Newer approaches to evaluating neurochemical abnormalities in schizophrenia include consideration of other neurotransmitter systems. Models of DA-serotonin (Meltzer 1989), DA-glutamate (Carlsson and Carlsson 1990), DA-acetylcholine (Tandon and Greden 1989), and DA-norepinephrine (van Kammen et al. 1990) interactions have been proposed. Although these models still accord DA a significant role in schizophrenia pathophysiology, they suggest that altered balance between DA and one (or more) of these other neurotransmitter systems may be the principal neurochemical abnormality related to the production of schizophrenic symptoms. Some of the earliest pharmacological treatments for schizophrenia included cholinergic agents (Cohen et al. 1944;Collard et al. 1946;Pfeiffer and Jenney 1957), and in the 1970s, several investigators suggested that cholinergic activity may be reduced in schizophrenia (Friedhoff and Alpert 1973;Janowsky et al. 1973;Davis et al. 1975;Singh and Kay 1979). There was no direct evidence of altered cholinergic functioning in schizophrenic patients, however, and pharmacological trials with cholinergic agents were generally ineffective (Rowntree et al. 1950;Gerlach et al. 1977;Davis and Berger 1978). With few exceptions (Johnstone et al. 1983;Singh et al. 1987), cholinergic mechanisms were increasingly considered irrelevant to the pathophysiology of schizophrenia and discussed predominantly with reference to the treatment of undesirable extrapyramidal side effects of neuroleptics (Richelson 1984). Indirect evidence from several lines of research, however, suggests that the cholinergic system may differentially influence positive and negative symptoms in schizophrenia (Tandon and Greden 1989).We and others have been conducting various studies to evaluate the role of the cholinergic system in schizophrenia, based on a primary hypothesis that DA-acetylcholine (ACh) interactions are of central importance in the production of positive and negative symptoms of schizophrenia (Tandon and Greden 1989;Tandon and Greden 1991). Based on available data and on observations of the course of positive and negative symptoms during the acute phase of the illness (Donlon and Blacker 1973;Docherty et al. 1978;Tandon et al. 1990a), we posited a role for disruption in DA-ACh balance in the expression of positive and negat...

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New atypical antipsychotic medications

Cited by 193 publications

References 12 publications

Adverse Events Associated With Organizational Factors of General Hospital Inpatient Psychiatric Care Environments

Adverse Events Associated With Organizational Factors of General Hospital Inpatient Psychiatric Care Environments

Towards a muscarinic hypothesis of schizophrenia

The Cholinergic System in Schizophrenia Reconsidered: Anticholinergic Modulation of Sleep and Symptom Profiles

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