Agitated symptom response to divalproex following acute brain injury.

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.

Alcohol level at head injury and subsequent psychotropic treatment during trauma critical care.

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.

Carbamazepine for combativeness in acute traumatic brain injury.

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.

Learning priorities of staff, residents, and students for a third-year psychiatric clerkship.

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.

A residency policy for pregnancy and parental leave.

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.