Intranasal midazolam for claustrophobia in MRI.

The authors present their preliminary results using intranasal midazolam for claustrophobic MRI patients. This route of administration reduced the necessity for intravenous sedation from 67 to 17% in this select group of patients. The only side effect encountered was a burning sensation of the nasal mucosa. Further investigation is necessary to determine the efficacy of intranasal midazolam in claustrophobic patients scheduled for MR examinations.

Phases of chronic pain: a model for assessment and treatment.

Chronic pain can be described as a syndrome or process of decompensation not unlike any other chronic disease or illness. As such, chronic pain patients are often difficult to work with because of the pervasive personal, social, emotional, and physical impact of the syndrome on their lives and the lives of their families. The pain curve was developed to be used as an educational instrument to assist patients in understanding the disease process, confronting denial, and self-diagnosing their illness. This curve now in use at our institution describes both the progression and the recovery of the illness. The pain curve is used as an educational tool to aid patients in addressing important recovery issues such as denial and the disease process, the progression of symptoms in a chronic illness, medication and alcohol use and abuse in the management of chronic pain, the impact on and from the family and the importance of peer support.

Guidelines for acute inpatient psychiatric treatment review.

Inpatient psychiatric care accounts for a major part of the health care dollars spent for mental illness. In this article the authors review the history and literature behind the process of psychiatric peer review and quality assurance and discuss the development of standard criteria for admission to the hospital. These criteria include (1) imminent danger to oneself and others, (2) acute impairment of ability to perform activities of daily life, (3) impulsive or assaultive behavior, and (4) management of withdrawal states. The authors then present an outline of the typical course of the hospital stay. Finally, through a series of questions, criteria for continued stay on an acute care unit are indicated. The essential criterion is medical necessity based on a standard of severity of illness and intensity of treatment required. Criteria for admission, a sense of the typical course of the hospital stay, and criteria for continued stay then become the relevant issues for psychiatric peer review and quality assessment.

Psychotherapists as suicide survivors.

This paper examines the effects of a patient's suicide on the treating psychotherapist. Psychotherapists were found to react to a suicide with feelings of disbelief, guilt, and shock. This was followed by grief, shame, despair, anger, and a loss of self confidence. The psychotherapists interviewed were permanently affected in two ways. First, the experience remained vividly in their minds. Second, they tended to no longer minimize suicidal behavior, attempts, and gestures. The experience allowed the psychotherapist to confront his grandiose rescue fantasies and to question his sense of security. A support group for the surviving psychotherapists is recommended that would allow them the opportunity to talk about the death. Training programs that would encourage the explicit exploration of suicidal issues, including the patient's responsibility for suicidal behavior, should be established. It is believed that managing the feelings about a patient's suicide needs to become an active process.