Units psychiatric

Owen C, Taratello C, Jones M, Tennant C. 1999. Violence and aggression in psychiatric units. Psychiatr Serv 49 1452-1457. 

Depression is a common psychiatric disorder. The lifetime risk of developing a depressive episode is estimated to be as high as 8—12% for men and 20—26% for women (116). Depression, one of the most widespread of all life-threatening disorders, is almost always a factor in the mote than 30,000 suicides that occur annually in the United States alone (117). 

Asa nurse on the psychiatric unit, you are assigned to discuss extrapyramidal effects at a team conference. Discuss how you would present and explain this topic. Describe the points you would stress. 

Adverse consequences of drinking include a variety of social, legal, medical, and psychiatric problems (Babor et al. 1987, 2003). Alcohol is among the top four causes of mortality in 1988, 107,800 deaths, or about 5% of all deaths in the United States, were attributed to alcohol-related causes (Stinson and DeBakey 1992). Approximately 17% of alcohol-related deaths were directly attributable to alcohol, 38% resulted from diseases indirecdy attributable to alcohol, and 45% were attributable to alcohol-related traumatic injury (U.S. Department of Health and Human Services 1994). Alcohol-related mortality declined during the latter part of the twentieth century. For example, the age-adjusted mortality rate from liver cirrhosis in 1993 (7.9 deaths per 100,000 persons) was just over half the rate in 1970 (14.6 deaths per 100,000) (Saadat-mand et al. 1997), and the proportion of automobile fatalities that was related to the use of alcohol fell to a two-decade low of 33.6% in 1993 (Lane et al. 1997). 

Kahkonen S Alcohol withdrawal changes cardiovascular responses to propranolol challenge. Neuropsychobiology 47 192—197, 2003 Kessler RC, McGonagle KA, Zhao S, et al Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry 51 8-19,1994... 

Prevalence of benzodiazepine use and abuse can be estimated by national and cross-national sutveys of the general population and of populations in medical clinics, psychiatric institutions, and chemical dependency tteatment units. 

In subjects with sedative-hypnotic dependence who underwent detoxification in an addictions treatment unit, a significant association was not found between abstinence rate and either gender or psychiatric status (Charney et al. 2000). Patients dependent on benzodiazepines reported decreased anxiety during follow-up, even though their use of these agents had decreased. 

Williams H, Oyefeso A, Ghodse AH Benzodiazepine misuse and dependence among opiate addicts in treatment. It J Psychol Med 13 62-64, 1996 Wiseman SM, Spencer-Peet J Prescribing for alcoholics a survey of drugs taken prior to admission to an alcoholism unit. Practitioner 229 88—89, 1985 Wolf B, Grohmann R, Biber D, et al Benzodiazepine abuse and dependence in psychiatric inpatients. Pharmacopsychiatry 22 54—60, 1989 Wood MR, Kim JJ, Han W, et al Benzodiazepines as potent and selective bradykinin B1 antagonists. J Med Chem 46 1803—1806, 2003 Zawertailo LA, Busto UE, Kaplan HL, et al Comparative abuse liability and pharmacological effects of meprobamate, triazolam, and butabarbital. J Clin Psycho-pharmacol 23 269-280, 2003... 

Chen CY, Wagner FA, Anthony JC Marijuana use and the risk of major depressive episode epidemiological evidence from the United States National Comorbidity Survey. Soc Psychiatry Psychiatr Epidemiol 37 199-206, 2002... 

Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry 8-19. 

The decline in Los Angeles between 1983 and 1984 cannot immediately be interpreted as a decline in PCP use for that city. In 1981, during an investigation of PCP trends in Los Angeles, it was discovered that many PCP emergencies were diverted to psychiatric units, better equipped to handle the violent behavior sometimes accompanying PCP reactions. These psychiatric units were not participating in the DAWN network at that time (Kozel and Husson 1981). It is possible that similar systemic problems may have occurred in 1984. 

Phencyclidine (PCP) abuse remains a serious public health problem in large urban areas of the United States, with recent trends suggesting increased use after a period of decline (Crider, this volume). Most clinical and research attention has focused on the psychiatric and medical manifestations of acute or subacute PCP intoxication, especially the organic mental disorders (toxic delirium, psychosis, or depression) that PCP can induce (McCarron et al. 1981 McCarron, this volume Sioris and Krenzelok 1978). 

MDD is quite common lifetime and 12-month prevalence estimates are 16.2% and 6.6%, respectively. Thus, approximately 35 million United States adults will experience MDD in their lifetime.2 Females are approximately twice as likely as males to experience MDD.2 Although MDD may begin at any age, the average age at onset is the mid-20s.3 Interestingly, MDD appears to occur earlier in life in people born in more recent decades.2 Most patients with MDD also suffer from comorbid psychiatric disorders, especially anxiety disorders and substance-use disorders.2... 

The Diagnostic and Statistical Manual of Mental Disorders (DSM) represents the most widely used psychiatric nosology in the United States. From a historical perspective, it appears that the major changes to the DSM have taken place to solve a few specific problems—particularly, problems with reliability. Over time, the DSM has done well in addressing problems related to reliability, but this evolution has raised many criticisms and has created additional problems. In this chapter, the history of the DSM is reviewed, along with the major criticisms that have been raised about its more recent versions. We also suggest taxometric analysis as one method that will prove useful in addressing many of the limitations of the current system. 

My husband recognized that he couldn t leave me by myself and he recognized his limitations, so we decided to get some help. I went into a hospital a couple of times. I spent two weeks in a psychiatric unit of a hospital. I needed to separate from what was going on. I wouldn t be here today if I hadn t had some medical intervention. I m very grateful for that resource. And some good counseling has helped me to express my feelings. But I have battled depression off and on. 

Fortunately, new treatments have greatly improved the plight of the patient with schizophrenia. Thanks in large part to the introduction of newer antipsychotic medications, few patients with this disease spend their lives in long-term psychiatric hospitals anymore. However, we have a long way to go. Individuals with schizophrenia are currently a sizeable proportion of both the homeless population and the prison population in the United States. Even with the great advances in schizophrenia treatment in the last 50 years, this illness still takes a tremendous toll on the lives of its sufferers and their families. 

ADHD is snrprisingly common. In fact, it is one of the most common psychiatric disorders affecting children. In the United States, somewhere between 3% and 5% of elementary school children have ADHD. This translates into an average of one or two children with ADHD in every classroom. 

Atomoxetine (Straterra , originally tomoxetine or tomoxetin, 3) was first described and synthesized by chemists at Eli Lilly in the late 1970s and was one of the few compounds that was known to display meaningful selectivity for the norepinephrine reuptake transporter (NET) versus the serotonin reuptake transporter (SERT) and the dopamine reuptake transporter (DAT) (Barnett, 1986 Molloy and Schmiegel, 1997). Atomoxetine was one of several structurally related and commercially successful monoamine reuptake inhibitors that were developed by Lilly for the treatment of various psychiatric disorders (Eig. 17.4). Fluoxetine (43) and duloxetine (44) have both gained approval in the United States as Prozac and Cymbalta , respectively, and nisoxetine (45) is widely used as a tool in biology. 

Kessler RC (2001) Comorbidity of depression and anxiety disorders. In Montgomery SA, den Boer JA (eds) SSRIs in depression and anxiety. Wiley, Chichester, pp 87-106 Kessler RC, Price RH (1993) Primary prevention of secondary disorders a proposal and agenda. Am J Community Psychol 21 607-633 Kessler RC, McGonagle KA, Zhao S (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 51 (1) 8-19... 

Regier DA, Narrow WE, Rae DS (1990) The epidemiology of anxiety disorders. The Epidemiologic Catchment Area (ECA) experience. J Psychiatr Res 24(Suppl 2) 3-14 Regier DA, Farmer ME, Rae DS, Mayers JK, Kramer M, Robins LN, George LK, Karno M, Locke BZ (1993) One-month-prevalence of mental disorders in the United States and sociodemographic characteristics The Epidemiologic Catchment Area Study. Acta Psychiatr Scand 88 35-47... 

In the United States, the three MAOIS available for the treatment of psychiatric conditions are phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan). All three agents have indications for adult major depression (>16 years old) and, more specifically, atypical depression (anergia, hypersomnia, hy-perphagia, somatization, and anxiety symptoms). Although not indicated for anxiety, the MAOIs can also be particularly helpful in treatment of these disorders. Selegiline or L-deprenyl (Eldepryl) is also available in the United States and indicated for symptoms of Parkinson s disease and depression. 

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