QTc, the Multitude of Ways It Is Calculated and Implications for Clinical Practice: A Case Example.

QTc stands for heart-rate corrected QT interval on the electrocardiogram and is a measure of the efficiency of repolarization of the left ventricle. Excessive prolongation, generally considered to be >500 ms, can result in a potentially fatal ventricular arrhythmia known as torsade de pointes. Some psychiatric medications can cause this arrhythmia and, therefore, this issue is important to all prescribers of psychiatric medications. It is also important to keep in mind that there are multiple algorithms used to calculate the QTc. The Bazett's algorithm, one of the most commonly used algorithms on electrocardiogram machines, can produce an artificially prolonged QTc; however, the use of this algorithm is not generally identified on the printout from the electrocardiogram machine, which can cause unnecessary concern and delay treatment of patients. For these reasons, this article explains the basic concepts of the QT interval and QTc interval and discusses why it is important for psychiatrists and other prescribers to know this information. A case report is then used to illustrate the clinical application of this knowledge so that effective treatment is not unnecessarily delayed.

Posttraumatic stress disorder: a serious post-earthquake complication.

OBJECTIVES: Earthquakes are unpredictable and devastating natural disasters. They can cause massive destruction and loss of life and survivors may suffer psychological symptoms of severe intensity. Our goal in this article is to review studies published in the last 20 years to compile what is known about posttraumatic stress disorder (PTSD) occurring after earthquakes. The review also describes other psychiatric complications that can be associated with earthquakes, to provide readers with better overall understanding, and discusses several sociodemographic factors that can be associated with post-earthquake PTSD. METHOD: A search for literature was conducted on major databases such as MEDLINE, PubMed, EMBASE, and PsycINFO and in neurology and psychiatry journals, and many other medical journals. Terms used for electronic searches included, but were not limited to, posttraumatic stress disorder (PTSD), posttraumatic symptoms, anxiety, depression, major depressive disorder, earthquake, and natural disaster. The relevant information was then utilized to determine the relationships between earthquakes and posttraumatic stress symptoms. RESULTS: It was found that PTSD is the most commonly occurring mental health condition among earthquake survivors. Major depressive disorder, generalized anxiety disorder, obsessive compulsive disorder, social phobia, and specific phobias were also listed. CONCLUSION: The PTSD prevalence rate varied widely. It was dependent on multiple risk factors in target populations and also on the interval of time that had elapsed between the exposure to the deadly incident and measurement. Females seemed to be the most widely-affected group, while elderly people and young children exhibit considerable psychosocial impact.

Pharmacokinetic drug evaluation of paliperidone in the treatment of schizoaffective disorder.

INTRODUCTION: This paper reviews the pharmacokinetics, receptor binding, clinical efficacy and safety of paliperidone in the treatment of patients with schizoaffective disorder. Areas covered: We reviewed the literature using keywords 'paliperidone', 'schizoaffective disorder' and 'clinical trials' with a focus on seminal data papers and information that is clinically relevant to the treatment of schizoaffective disorder. The purpose of this paper is to provide a clinically oriented review of the pharmacokinetic and pharmacodynamic properties of paliperidone including receptor binding, clinical efficacy, safety and tolerability. Expert opinion: Paliperidone is currently the only medication FDA approved specifically for the treatment of schizoaffective disorder. Paliperidone is an active metabolite of risperidone, is minimally metabolized in the liver and is primarily known to be cleared through the kidneys. For this reason, paliperidone could be considered for some patients with schizoaffective disorder who also have hepatic impairment. After correcting for the reduced protein binding that is characteristic of hepatically impaired patients, the Cmax was 12% lower than in healthy subjects while the AUC and CL/F were comparable [14]. In addition, the availability of long acting injectable formulations may be useful for patients who are non-adherent with oral medications. The cost of paliperidone may be a disadvantage.

Posttraumatic stress disorder: a serious post-earthquake complication / Transtorno do estresse pós-traumático: complicação séria pós-terremoto

Abstract Objectives Earthquakes are unpredictable and devastating natural disasters. They can cause massive destruction and loss of life and survivors may suffer psychological symptoms of severe intensity. Our goal in this article is to review studies published in the last 20 years to compile what is known about posttraumatic stress disorder (PTSD) occurring after earthquakes. The review also describes other psychiatric complications that can be associated with earthquakes, to provide readers with better overall understanding, and discusses several sociodemographic factors that can be associated with post-earthquake PTSD Method A search for literature was conducted on major databases such as MEDLINE, PubMed, EMBASE, and PsycINFO and in neurology and psychiatry journals, and many other medical journals. Terms used for electronic searches included, but were not limited to, posttraumatic stress disorder (PTSD), posttraumatic symptoms, anxiety, depression, major depressive disorder, earthquake, and natural disaster. The relevant information was then utilized to determine the relationships between earthquakes and posttraumatic stress symptoms. Results It was found that PTSD is the most commonly occurring mental health condition among earthquake survivors. Major depressive disorder, generalized anxiety disorder, obsessive compulsive disorder, social phobia, and specific phobias were also listed. Conclusion The PTSD prevalence rate varied widely. It was dependent on multiple risk factors in target populations and also on the interval of time that had elapsed between the exposure to the deadly incident and measurement. Females seemed to be the most widely-affected group, while elderly people and young children exhibit considerable psychosocial impact.

Resumo Objetivos Terremotos são desastres naturais imprevisíveis e devastadores. Eles podem causar destruição em massa e morte, e os sobreviventes podem apresentar sintomas psicológicos severos. O objetivo deste estudo foi revisar estudos publicados nos últimos 20 anos pra compilar o conhecimento disponível acerca da ocorrência de transtorno do estresse pós-traumático (TEPT) após terremotos. A revisão também descreve outras complicações psiquiátricas que podem estar associadas a terremotos, oferecendo aos leitores um melhor entendimento geral sobre o assunto, e discute vários fatores sociodemográficos que podem estar associados com TEPT pós-terremoto. Métodos Foi realizada uma busca de literatura nas principais bases de dados, como MEDLINE, PubMed, EMBASE e PsycINFO, e também em revistas de neurologia e psiquiatria, e vários outros periódicos médicos. Os termos usados nas buscas eletrônicas incluíram, mas não se limitaram a, posttraumatic stress disorder (PTSD), posttraumatic symptoms, anxiety, depression, major depressive disorder, earthquake e natural disaster. As informações relevantes foram então utilizadas para determinar as relações entre terremotos e sintomas de estresse pós-traumático. Resultados A revisão revelou que o TEPT é a condição de saúde mental mais comum em sobreviventes de terremoto. Depressão maior, transtorno de ansiedade generalizada, transtorno obsessivo-compulsivo, fobia social e fobias específicas foram outras condições encontrados. Conclusão A prevalência de TEPT variou bastante. O transtorno foi dependente de múltiplos fatores de risco em populações-alvo e também do intervalo de tempo decorrido entre a exposição ao incidente fatal e a avaliação. As mulheres pareceram ser o grupo mais amplamente afetado, ao passo que idosos e crianças demonstração considerável impacto psicossocial.

Misconceptions of depression in african americans.

Major depression is a very common disabling disorder. Although the relationship between race and depression is complex, depression affects all races, all ethnic and geographic locations as well as all age groups. The prevalence of depression in African Americans is controversial, due to the paucity of research. The deficit in the knowledge and skills in treating depression in African Americans have not been adequately addressed so far. Inadequate and insufficient data on African Americans contributes to the problems of under diagnoses, misdiagnosis, and under treatment of depression. This article will highlight the existing problem of depression in Afro American with a focus on diagnostic and treatment issues.

How to evaluate disability.

A disability assessment for non-therapeutic reasons is the most common evaluation requested of treating psychiatrists. Mental disorders affect approximately 20 percent of Americans each year. People who are unable to work need some financial assistance. As part of the system, it's our goal to assist them in this process. When a disability claim is filed, psychiatrists take into account the individual's impairments and disabilities. A psychiatrist's evaluation of disability involves knowledge and experience. There are many ethics related challenges, especially when performing disability evaluation of their own patients. Disability training should therefore be part of residency curriculum for training of psychiatry residents.