ABSTRACT
No medications clearly enhance consciousness or cognition following severe brain injury. This series (n = 13) suggests that lamotrigine may stimulate improvement of patients with impairment equivalent to level I-III on the Rancho Los Amigos Cognitive Scale. After a serendiptious clinical result, severely brain injured patients who were taking an anticonvulsant had an opportunity to start lamotrigine. This cohort had been transferred to this rehabilitation unit 14-304 (mean 73.9) days and started lamotrigine 20-310 (mean 87.5) days after acute brain injury. Compared to this unit's experience with patients with similar severe brain injuries, more patients (n = 10) were discharged to the conmmunity and fewer to skilled nursing facilities (n = 3) than were expected. This preliminary and provocative case series corresponds to basic science results, and further investigation of lamotrigine is warranted.
Subject(s)
Brain Injuries/drug therapy , Brain Injuries/rehabilitation , Cognition/drug effects , Excitatory Amino Acid Antagonists/therapeutic use , Seizures/prevention & control , Triazines/therapeutic use , Activities of Daily Living , Adult , Aged , Anticonvulsants/administration & dosage , Anticonvulsants/therapeutic use , Brain Injuries/complications , Brain Injuries/psychology , Excitatory Amino Acid Antagonists/administration & dosage , Female , Humans , Lamotrigine , Male , Middle Aged , Patient Discharge/statistics & numerical data , Psychiatric Status Rating Scales , Recovery of Function , Seizures/etiology , Trauma Severity Indices , Triazines/administration & dosageABSTRACT
This is the largest case series (N=29) to date describing divalproex for agitation symptoms. Chart information was abstracted retrospectively for all patients who received divalproex for agitation symptoms during a 22-month period in one inpatient brain injury rehabilitation unit. For 26 patients (90%), divalproex appeared effective within 7 days after a typical 1,250 mg/day dose. Most patients (93%) were discharged to their home or community sites. Divalproex appears to be an efficacious alternative to neuroleptics and benzodiazepines for alert, labile, impulsive, and disinhibited brain injury patients.
Subject(s)
Antimanic Agents/therapeutic use , Brain Injuries/psychology , Psychomotor Agitation/drug therapy , Psychomotor Agitation/etiology , Valproic Acid/therapeutic use , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Antimanic Agents/administration & dosage , Cohort Studies , Humans , Middle Aged , Retrospective Studies , Treatment Outcome , Valproic Acid/administration & dosageABSTRACT
Self-immolation represented 3.9% of patients (N = 7) at this burn unit over the last 18 months. Charts of these patients were retrospectively reviewed for demographics, hospital course, and discharge plan. All had a major psychiatric diagnosis, although no clear patient profile emerged. These patients required complex individualized care, but the psychosocial treatment challenges had many common elements. Psychiatric aspects of these patients proved problematic for the burn unit staff. Physical sequelae of the burns raised problems in arranging subsequent psychiatric treatment. Follow-up information was obtained by brief telephone interviews. The survivors appeared to be functioning well given their psychopathology and physical sequelae.
Subject(s)
Burns/psychology , Patient Care Team , Psychotherapy , Self-Injurious Behavior/psychology , Suicide, Attempted/psychology , Adult , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Readmission , Psychotic Disorders/psychology , Psychotic Disorders/therapy , Self-Injurious Behavior/therapy , Suicide, Attempted/prevention & control , Treatment OutcomeABSTRACT
Alcohol intoxication at the time of traumatic brain injury (TBI) presents many complications for critical care treatment. This is the first reported data on psychotropic dosages administered to TBI patients in the critical care setting. In this study, the blood alcohol level (BAL)-positive patients (n = 14) tended to be older (P = 0.095), have lower admission Glascow Coma Scores (P = 0.031), and spent more days on respirators (P = 0.125) than the BAL-zero patients (n = 21). The BAL-positive group received more days of narcotics and benzodiazepines with markedly higher average daily doses, not statistically significant. These results are a basis for studying relationships between medication, treatment variables, and outcomes for TBI patients and then developing specific medication guidelines.
Subject(s)
Alcoholic Intoxication/complications , Alcoholic Intoxication/diagnosis , Brain Injuries/complications , Adolescent , Adult , Brain Injuries/diagnosis , Brain Injuries/drug therapy , Cohort Studies , Glasgow Coma Scale , Humans , Middle Aged , Prospective Studies , Psychotropic Drugs/therapeutic useABSTRACT
Psychiatrists increasingly consult on the treatment of acute traumatic brain injury (TBI) when combativeness compromises safe critical care. The author discusses use of carbamazepine for 7 combative patients with multiple trauma including TBI. This cohort had a clinical decrease in combativeness within 4 days after carbamazepine, compared with this Level I trauma center's experience of prolonged combative periods without its use.
Subject(s)
Aggression/drug effects , Brain Injuries/psychology , Carbamazepine/therapeutic use , Accidents, Traffic , Adult , Brain Injuries/complications , Critical Care , Female , Humans , Male , Multiple Trauma/psychology , Skiing/injuriesABSTRACT
Psychiatric clerkships combine classroom instruction with patient care. The different learning experiences in those two settings prompted the authors to survey 86 third-year medical student clerks, 44 staff psychiatrists, and 15 PGY-2 psychiatric residents about the importance of 31 skill and knowledge areas as learning goals for clerks. All groups of respondents included the following five items (16.2%) among the most important: performing a mental status examination, becoming comfortable with psychiatric patients, evaluating suicidally, developing interview skills, and suspecting drug and alcohol problems. The importance placed by staff on aspects of the doctor-patient relationship was not apparent to students, who perceived psychiatric diagnosis as receiving higher priority than staff intended. The implications of these findings for curriculum planning are discussed.
Subject(s)
Hospitals, Military/statistics & numerical data , Mental Disorders/epidemiology , Military Personnel/statistics & numerical data , Neurocognitive Disorders/epidemiology , Adult , Cross-Sectional Studies , District of Columbia/epidemiology , Female , Humans , Incidence , Male , Mental Disorders/diagnosis , Mental Disorders/psychology , Military Personnel/psychology , Neurocognitive Disorders/diagnosis , Neurocognitive Disorders/psychology , Psychiatric Department, Hospital/statistics & numerical dataABSTRACT
Residency programs need to anticipate the parental needs of their residents as more residents have children during residency. Ad hoc or crisis mode responses to resident pregnancy result in individual and group distress and dysfunction. Described in this paper is a maternity and parental leave policy for a psychiatric training program at a military hospital. This policy provides a framework for policies in other residency and military work situations.
