ABSTRACT
INTRODUCTION: Though not approved by the United States Food and Drug Administration, intravenous haloperidol (IVH) is widely used off-label to manage agitation and psychosis in patients with delirium in the hospital setting. Over the years, concerns have emerged regarding side effects of IVH, particularly its potential to cause QT prolongation, torsades de pointes (TdP), extrapyramidal symptoms and catatonia. METHODS: We conducted a systematic review of literature of published literature related to side effects of IVH in PubMed in accordance with PRISMA guidelines. RESULTS: 77 of 196 identified manuscripts met inclusion criteria, including 34 clinical trials and 34 case reports or series. DISCUSSION: Extrapyramidal symptoms, catatonia and neuroleptic malignant syndrome appears to be relatively rare with IVH. In most prospective studies, IVH did not cause greater QT prolongation than placebo, and rates of TdP with IVH appear to be low. There is not clear evidence to suggest that IVH carries greater risk for QT prolongation or TdP than other antipsychotics. CONCLUSIONS: Based on the available literature, we provide modified evidence-based monitoring recommendations for clinicians prescribing IVH in hospital settings. Specifically, we recommend electrocardiogram monitoring only when using doses >5 mg of IVH and telemetry only for high-risk patients receiving cumulative doses of at least 100 mg or with accurately corrected QTc >500 ms.
Subject(s)
Antipsychotic Agents , Long QT Syndrome , Torsades de Pointes , Antipsychotic Agents/adverse effects , Electrocardiography , Haloperidol/adverse effects , Humans , Prospective StudiesABSTRACT
BACKGROUND: Studies have long described the efficacy of electroconvulsive therapy (ECT); however, access to care continues to be an obstacle to treatment. Despite national trends resulting in declining availability of ECT, a new academic service was created to serve the needs of an area with limited resources. In this study, the characteristics and outcomes of patients receiving treatment during the first year of a new ECT program were assessed. The goals were to analyze treatment outcomes in this population and to identify associations between patient characteristics, treatment parameters, and clinical response. METHODS: Medical charts from the first 49 patients undergoing ECT between October 2010 and September 2011 were retrospectively reviewed. Patient characteristics, indications for ECT, and treatment parameters were compared with clinical improvement as defined by the Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS: Of the 46 patients included in this study, the majority were female (63%), Caucasian (89%), and diagnosed with major depressive disorder (63%). The acute series duration ranged from 3 to 29 treatments (median of 13), with 50% (n=23) of patients achieving remission (MADRS<10) and 78% (n=36) achieving response (MADRS reduction > 50%) at the completion of the acute series. Positive outcomes were found to be associated with a history of medication-resistant conditions. CONCLUSIONS: ECT is a highly effective intervention for the treatment of depression and continues to be a sought-after therapy. Efficacy rates in the first year of this service were comparable to what has been reported in the general population and emphasize the need for the continued availability of ECT as a treatment option.
Subject(s)
Depressive Disorder/therapy , Electroconvulsive Therapy/statistics & numerical data , Treatment Outcome , Academic Medical Centers/methods , Academic Medical Centers/statistics & numerical data , Adult , Aged , Depressive Disorder, Major/therapy , Depressive Disorder, Treatment-Resistant/therapy , Electroconvulsive Therapy/methods , Female , Humans , Male , Mental Health Services/statistics & numerical data , Middle Aged , Program Evaluation , Retrospective Studies , Young AdultABSTRACT
Charles Bonnet syndrome (CBS) is a clinical entity in which patients develop vivid visual hallucinations in the absence of psychiatric illness. In the great majority of cases, a decline in visual acuity precedes the development of CBS. The patient maintains intact reality testing and recognizes that the hallucinations are not real. There is no definitive cure for CBS, although various pharmacologic agents, behavioral strategies, and ophthalmologic interventions have been used in an attempt to reduce or relieve symptoms. We present the case of a 79-year-old man who presented with the onset of vivid visual hallucinations after developing cataracts. We also review previous case reports of CBS and discuss treatment options.
