ABSTRACT
The use of neuroleptics in the elderly has been a topic of debate since 2005 when the US Food and Drug Administration issued a black-box warning of increased risk of mortality in elderly patients with dementia-related psychosis. Antipsychotic alternatives such as divalproex are sometimes favored on an "off-label" basis to manage agitation in the demented elderly, and antipsychotic use is often clinically necessary to treat psychosis in older adults, with or without dementia. Concurrently, risk for iatrogenic corrected QT (QTc) prolongation on electrocardiogram (ECG) remains a concern with the use of many antipsychotic agents because of its associated potential for fatal arrhythmias.
Subject(s)
Antipsychotic Agents/administration & dosage , Aripiprazole/administration & dosage , Bipolar Disorder/drug therapy , Long QT Syndrome/physiopathology , Aged, 80 and over , Antipsychotic Agents/adverse effects , Aripiprazole/adverse effects , Female , Humans , Long QT Syndrome/chemically inducedABSTRACT
BACKGROUND: The triple disaster that struck the Tohoku region on March 11, 2011, has had massive psychiatric, social, and physical effects on the people of Japan. A staggering loss of life and property, as well as an ongoing nuclear disaster, has dramatically affected the ability of the country to recover. OBJECTIVE: In an effort to better understand the current social, health, and mental health needs of the region affected by the disaster and to share lessons from 9/11, a group of 9/11 survivors and doctors from the Icahn School of Medicine at Mount Sinai traveled to sites throughout the Fukushima, Miyagi, and Iwate prefectures. METHODS: A qualitative analysis was performed on transcripts of the cultural and medical exchanges, which occurred on this trip to identify relevant themes about the problems confronting the recovery effort almost 3 years after the disaster. FINDINGS: Significant themes that emerged included a crippling radiation anxiety, a considerable stigma toward addressing mental health care, and a shortage of mental health care throughout the region, as well as ongoing psychiatric symptoms such as insomnia, anxiety, and alcohol misuse. CONCLUSIONS: These issues continue to complicate the recovery effort but suggest avenues for future interventions.
