Chart review

Your job is to look at all of the factors and make an informed decision. Let s put everything we saw into one chart. Review the chart. If there are any parts that do not make sense, you should return to the section on that factor and review the concepts. 

Procyshyn and Zerjav (1998) Retrospective chart review (Canada) Olanzapine (30) and risperidone (30)... 

Qureshi et al." evaluated the timing of deterioration in patients with massive MCA strokes in a multicenter retrospective chart review. They found that 68% of patients manifested clinical deterioration by 48 hours, and nearly another 20% did so by 72 hours. Thus, the first 3-5 days appears to be the most crucial time for detecting patients at high risk for deterioration, although there was a small minority of patients who had deterioration at greater than 5 days from symptom onset. Early impairment in consciousness was also found to be predictive of mortality in one cohort of patients within a randomized chnical trial." One postmortem study of 192 patients found features in 45 patients that they postulate led to mahgnant ... 

The entire causal factor chart is then reviewed to identify any omissions or gaps in the chronology. Additional effort is required to gather further evidence to close these gaps. If new data are inserted into the timeline, the sequence should be retested for sufficiency. Some gaps may remain even after this additional effort. The causal factor chart review should also identify and eliminate any facts that are not necessary to describe the incident. Detailed rules for causal factor charting are shown in Figure 9-7. 

HIV involvement. The prevalence, predictors, and patterns of cannabis use—specifically medicinal cannabis use among patients with HIV—were examined. Any cannabis use in the year prior to interview and self-defined medicinal use were evaluated. A cross-sectional multicenter survey and retrospective chart review were conducted to evaluate overall drug utilization in HIV, including cannabis use. HIV-positive adults were identified through the HIV Ontario Observational Database 104 consenting patients were interviewed. Forty-three percent of the patients reported cannabis use, whereas 29% reported medicinal use. Reasons for use were similar by gender although... 

Prince, J.B., Wilens, T.E., Biederman, J., Spencer, T.J., and Wozniak, J.R. (1996) Clonidine for sleep disturbances associated with attention-deficit hyperactivity disorder a sysrematic chart review of 62 cases. / Am Acad Child Adolesc Psychiatry 35 599-605. 

In a retrospective chart review of 352 adult patients treated in an outpatient clinic with SSRI medications, 171 patients who had supervised discontinuation of their medication were compared to those who stayed on medication (Coupland et ah, 1996). The most common withdrawal symptom was, again, dizziness, but paresthesias, asthenia, nausea, visual disturbances, and headache were also common. Movement-induced exacerbation of symptoms were associated with discontinuation of paroxetine (16.0%) and fluvoxamine (7.0%). It seems prudent to recommend gradual titra-... 

Biederman, J., Mick, E., Bostic, J.Q., Prince, J., Daly, J., Wilens, T.E., Spencer, T., Garcia-Jetton, J., Russell, R., Wozniak, J., and Far-aone, S.V. (1998) The naturalistic course of pharmacologic treatment of children with maniclike symptoms a systematic chart review. / Clin Psychiatry 59 62 -6ih7-, quiz 38. 

Martin, A., Landau, J., Leebens, P., Ulizio, K., Cicchetti, D., Scahill, L., and Leckman, J.E (2000) Risperidone-associated weight gain in children and adolescents a retrospective chart review. / Child Adolesc Psychopharmacol 10 235-244. 

Studies of TCAs have uniformly reported a robust rate of response of ADHD symptoms in ADHD subjects with comorbid depression or anxiety (Cox 1982 Biederman et ah, 1993b Wilens et ah, 1993, 1995). In addition, studies of TCAs have consistently reported a robust rate of response in ADHD subjects with comorbid tic disorders (Dillon et ah, 1985 Hoge and Biederman, 1986 Riddle et ah, 1988 Spencer et ah, 1993a,b Singer et ah, 1994). For example, in a recent controlled study, Spencer et al. replicated data from a retrospective chart review, indicating that DMI had a robust beneficial effect on ADHD and tic symptoms (Spencer, 1997). 

Chart reviews and open trials of outpatients with bipolar disorder and bipolar spectrum disorder have been published for 28 risperidone- and 23 olanzapine-treated treated children and adolescents (Frazier et ah, 1999 2001). Significant decreases in mania, depression, and aggression ratings occurred over the course of treatment however, other medications were also used simultaneously. Additional anecdotal information exists for olanzapine (Soutullo et ah, 1999 Chang and Ketter, 2000), quetiapine (Schaller and Behar, 1999), and clozapine (Fuchs, 1994). 

Frazier, J.A., Meyer, M.C., Biederman, J., Wozniak, J., Wilens, T, Spencer, T, Kim, G., and Shapiro, S. (1999) Risperidone treatment for juvenile bipolar disorder a retrospective chart review./ Am Acad Child Adolesc Psychiatry 38 960—965. 

Although studies reviewed thus far support the efficacy of lithium treatment for acute mania, the presence of concurrent depression or depressive symptoms during mania, the so-called mixed state, has been associated with poor lithium response. In 1976, Himmelhoch et al. observed that patients with mixed states were significantly less likely to demonstrate a good treatment response than were manic patients [42% vs. 81%] in a retrospective chart review of 84 consecutively referred patients with bipolar disorder. Secunda et al. [1985] reported on 18 patients with mania studied as part of the Collaborative Study of the Psychobiology of Depression and found that patients with concomitant depression and mania [n = 8] had a significantly lower rate of... 

The notes, comments, and data in the charts reflected what must have been a supportive and well-staffed research unit. The only negative comments from subjects in the charts had to do with the quality or preparation of the food. Many positive comments reflecting careful attention, support, and, in general, informed participation in the experiments occurred throughout the charts over the years. Retropective chart reviews always involve guessing and speculation. 

The following summary of acute effects in humans is based primarily on a review of the charts in the clinical files at Edgewood. Like many clinical records, these vary greatly in extent of detail, ranging from sketchy and Incomplete notes or one-line summaries to records that could serve as models for research documents. Independent chart reviews by NRC scientists provided some cross-checks on... 

It is important to distinguish between acute (e.g., 1 day) and longer term treatment with a BZD. Most of the literature addressing this issue consists of anecdotal reports, retrospective chart reviews, and uncontrolled studies in small patient samples, plus a small number of controlled trials for short-term acute BZD therapy. To our knowledge, at least 12 studies (including more than 450 patients) have evaluated the efficacy of adjunctive BZDs in nonresponsive schizophrenics (Table 5-23). Two of three open studies showed positive results, as did two controlled, single-blind studies ( 343, 344, 345, 346 and 347). In seven double-blind, crossover studies (six with placebo controls), the results are more contradictory, in that five showed no advantage to an adjunctive BZD, and one of the two positive studies had a small sample size (188, 189, 348, 349, 350 and 351). 

There is also evidence of the prophylactic effect of antiparkinsonian drugs from a chart review study showing that they substantially prevented EPS ( 454). 

Lithium Plus Benzodiazepines. Unfortunately, two retrospective chart reviews at the Connecticut Mental Flealth Center found that a substantial number of manic patients started on an antipsychotic while hospitalized were still on these agents 6 months after discharge and that chronic neuroleptic treatment occurred frequently... 

Clozapine Longitudinal Trials. In a naturalistic study design, Banov et al. (300) found clozapine was an effective long-term treatment in mood disorders, particularly nondepressed affective patients. After a chart review, the authors identified 193 treatment-resistant patients, including the following ... 

Seizures have been reported after withdrawal of high doses of triazolam or relatively low doses combined with alcohol ( 347, 348 and 349). The FDA has reported a signal of an association for withdrawal seizures associated with triazolam ( 350). In a chart review of 150 consecutive patients withdrawn from BZDs, three of 25 triazolam patients experienced seizures, compared with two of 125 given other BZDs ( 351). Psychosis with delirium also has been reported after discontinuation of high triazolam doses (352). 

Finally, consistent with the impression that novel antipsychotics may have mood-regulating properties in adults, a recent retrospective chart review found risperidone helpful for manic and aggressive symptoms in 28 juvenile manic patients (208). 

In Cole s previously mentioned retrospective chart review of BPD, all nine patients falling into the schizophrenic group were given antipsychotics and improved. In addition, three of four patients with major depression who received antipsychotics alone also responded. By contrast, four patients with core BPD without psychosis or depression did not improve on antipsychotics. 

Halman et al. (491) conducted a retrospective chart review on 11 patients who were HIV-positive and presented with an acute manic episode. Whereas the six patients with abnormal MRI findings demonstrated intolerance to standard drug treatment (i.e., lithium, conventional neuroleptics), all benefited from a trial with an anticonvulsant (e.g., valproate, CBZ, clonazepam). 

Wilens TE, Biederman J, Geist DE, et al. Nortriptyline in the treatment of ADHD a chart review of 58 cases. J Am Acad Child Adolesc Psychiatry 1993 32 343-349. 

Frazier JA, Meyer MC, Biederman J, etal. Risperidone treatment for juvenile bipolar disorder a retrospective chart review. J Am Acad Child Adolesc Psychiatry 1999 38 960-965. 

The effect of dexamethasone has been assessed in a retrospective chart review study in neonates weighing less than 1200 g, both with (n = 65) and without (n = 269) Candida sepsis dexamethasone therapy and prolonged antibiotic therapy were associated with Candida infection (342). 

There was a higher rate of hyperglycemia with gatiflox-acin or levofloxacin compared with ceftriaxone in a retrospective chart review of 17 000 patients (413). Sulfonylurea therapy was identified as an independent risk factor for hypoglycemia. 

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