ABSTRACT
The authors present 6 cases of factitious disorder seen on a general adult inpatient psychiatry unit of a university hospital. They review the clinical features of this disorder and suggest that factitious disorder is much more prevalent among psychiatric inpatients than is commonly recognized. Strategies to assist in the diagnosis and management this disorder are detailed.
Subject(s)
Factitious Disorders/epidemiology , Factitious Disorders/psychology , Psychiatric Department, Hospital , Adult , Factitious Disorders/rehabilitation , Female , Hospitalization , Humans , Male , Middle Aged , Munchausen Syndrome/epidemiology , Munchausen Syndrome/psychology , Munchausen Syndrome/rehabilitation , Prevalence , Somatoform Disorders/epidemiology , Somatoform Disorders/psychology , Somatoform Disorders/rehabilitationABSTRACT
BACKGROUND: At least 50% of patients with anxiety disorders experience only partial response to pharmacotherapy and require augmentation therapy. Gamma-aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the CNS, and agents that modulate GABA neurotransmission have shown promise in the treatment of anxiety disorders and are often used as augmentation agents. OBJECTIVE: This study evaluated tiagabine, a selective GABA reuptake inhibitor (SGRI), as augmentation therapy. METHODS: This 8-week, open-label study enrolled patients who remained symptomatic despite adequate drug trials for treatment of anxiety symptoms. Tiagabine augmentation therapy was initiated at 4 mg/d (taken in 2 doses; one in the morning with breakfast and one in the evening with a snack) for 2 days and increased to 8 mg/d for 10 days. Dose was then adjusted according to efficacy/tolerability in increments of 2 mg every 3 days up to a maximum of 20 mg/d. Effect was assessed using the Hamilton Rating Scale for Anxiety (HAM-A), Beck Anxiety Inventory (BAI), Clinical Global Impression (CGI) scale, Pittsburgh Sleep Quality Index (PSQI), and 36-item Short-Form Health Survey (SF-36). RESULTS: Of the 18 patients enrolled, 17 were included in the efficacy analysis; one withdrew due to an adverse event prior to post-baseline assessment. Mean final dose of tiagabine was 13 mg/d. Tiagabine as augmentation therapy further reduced anxiety symptoms, as shown by significant decreases in mean HAM-A total and BAI scores at Week 8 (P<0.001). Thirteen patients (76%) responded (> or =50% reduction in HAM-A total score), and 10 patients (59%) achieved remission (HAM-A total score < or =7) at Week 8. Tiagabine improved sleep quality, with a significant reduction seen in PSQI global score at Week 8 (P=.001). Augmentation therapy with tiagabine was generally well tolerated. CONCLUSION: These preliminary findings suggest that the SGRI tiagabine may be an effective and generally well tolerated augmentation therapy in patients with anxiety who remain symptomatic despite adequate drug trials for treatment of anxiety symptoms.
Subject(s)
Anti-Anxiety Agents/administration & dosage , Anxiety Disorders/drug therapy , GABA Agonists/administration & dosage , Nipecotic Acids/administration & dosage , Adult , Anti-Anxiety Agents/adverse effects , Anxiety Disorders/diagnosis , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , GABA Agonists/adverse effects , Humans , Male , Middle Aged , Nipecotic Acids/adverse effects , Personality Inventory , Tiagabine , Treatment OutcomeABSTRACT
OBJECTIVE: To compare the effectiveness and tolerability of two hypnotic agents, trazadone (Desyrel) and zaleplon (Sonata) on psychiatric inpatients with insomnia. METHODS: Fifteen patients who were psychiatric inpatients were assigned openly and randomly to receive either trazodone (50-100 mg) or zaleplon (10-20 mg) doses on an "as-needed basis" and followed throughout their hospital stay. Efficacy and side effect profile were subsequently assessed. CONCLUSION: This pilot study suggests that trazodone may be a better agent to promote longer, deeper subjective quality sleep for psychiatric inpatients with insomnia in terms of effectiveness. However, tolerability was much better with zaleplon as daytime residual side effects were less.
Subject(s)
Acetamides/therapeutic use , Hypnotics and Sedatives/therapeutic use , Mental Disorders/complications , Pyrimidines/therapeutic use , Selective Serotonin Reuptake Inhibitors/therapeutic use , Sleep Initiation and Maintenance Disorders/drug therapy , Trazodone/therapeutic use , Administration, Oral , Adolescent , Adult , Aged , Drug Monitoring , Female , Humans , Inpatients , Male , Middle Aged , Pilot Projects , Prospective Studies , Sleep Initiation and Maintenance Disorders/complications , Sleep Initiation and Maintenance Disorders/diagnosis , Time Factors , Treatment OutcomeSubject(s)
Anti-Obesity Agents/therapeutic use , Antidepressive Agents/adverse effects , Diet, Reducing , Enzyme Inhibitors/therapeutic use , Exercise , Lactones/therapeutic use , Weight Gain/drug effects , Adult , Anti-Obesity Agents/adverse effects , Antidepressive Agents/therapeutic use , Body Composition/drug effects , Body Mass Index , Case-Control Studies , Enzyme Inhibitors/adverse effects , Female , Humans , Lactones/adverse effects , Male , Orlistat , Pilot Projects , Prospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: This study attempted to determine if extended-release venlafaxine is safe for use in severely medically and surgically ill depressed patients. METHOD: The charts of 16 patients who were admitted to medical and surgical inpatient services and given extended-release venlafaxine were retrospectively evaluated for dose and duration of drug treatment, blood pressure changes, medication changes, and side effects. RESULTS: There was 50%-75% improvement in depressive symptoms, with a statistically insignificant mean elevation in blood pressure. CONCLUSIONS: Extended-release venlafaxine appears to be a safe and tolerable agent for the medical-surgical depressed inpatient.
Subject(s)
Critical Illness/psychology , Cyclohexanols/therapeutic use , Depressive Disorder, Major/drug therapy , Depressive Disorder, Major/etiology , Drug Tolerance , Postoperative Complications/psychology , Selective Serotonin Reuptake Inhibitors/therapeutic use , Adult , Aged , Aged, 80 and over , Cyclohexanols/administration & dosage , Cyclohexanols/adverse effects , Delayed-Action Preparations , Depressive Disorder, Major/diagnosis , Female , Humans , Male , Middle Aged , Retrospective Studies , Selective Serotonin Reuptake Inhibitors/administration & dosage , Selective Serotonin Reuptake Inhibitors/adverse effects , Severity of Illness Index , Venlafaxine HydrochlorideABSTRACT
There has been widespread speculation that patients with sickle cell disease (SCD) may become drug dependent if their painful crisis is treated with narcotics. However, there has been no scientific evidence to support this assertion. Paradoxically, individuals suffering from sickle cell disease who are not adequately treated may develop an addiction to narcotics due to self-medication to treat their pain. In this article, we describe a 38-year-old African American woman who became addicted to cocaine due to self-medication of her sickle cell pain with cocaine.
