Nicotine replacement methods on a psychiatric unit.

UNLABELLED: Patients with psychiatric illness smoke more heavily than others in the community. They have more difficulty quitting and have more withdrawal symptoms than others. OBJECTIVE: The purpose of the present study was to examine the utilization of nicotine replacement methods in a population of psychiatric patients. METHOD: In a naturalistic retrospective review, we examined the records of 55 patients who were hospitalized on a smoke-free psychiatric unit. We abstracted the frequency of utilization of nicotine replacement. The rate of utilization was considered a ratio of the number of days utilized to the number of days prescribed. RESULTS: There were 38 patients (69%) who used the transdermal patch, 26 patients (47%) used the inhaler, 4 patients (7%) used nicotine gum, and 2 patients (4%) used the nasal spray. The rate of utilization of the nicotine inhaler (63%) exceeded that of the transdermal nicotine patch (30%) (t = 4.6, p < .0001). CONCLUSION: The hospitalization of smokers with mental illness in smoke-free psychiatric units often leads to further behavioral deterioration. The patients in the present study demonstrated a definite preference for the nicotine inhaler over the transdermal patch. Possible clinical and pathophysiological implications of this finding are discussed.

Substance dependence and the use of pro re nata anxiolytic/hypnotic drugs in a hospital setting.

Patients hospitalized for treatment of psychiatric illness commonly receive pro re nata (p.r.n.) anti-anxiety and hypnotic agents. The relationship between illicit drug use and p.r.n. anti-anxiety/hypnotic drug use in hospitalized psychiatric patients has not been extensively examined. The purpose of the present study was to examine this relationship. A retrospective review of 99 randomly selected hospitalized patients abstracted information regarding the utilization of p.r.n. anxiolytic and hypnotic medications. Seventy percent of the patients surveyed evidenced substance dependence. The substance users utilized p.r.n. anxiolytics (t = 2.29, df = 81, p < .05) and bedtime hypnotics (t = 4.23, df = 90, p < .0001) more frequently than the nonusers. Hospitalized substance abusers appear to continue their substance abuse in the hospital, substituting prescription preparations for illicit drugs. Nevertheless, cumulative literature now suggests that p.r.n. anxiolytic and hypnotic agents play a critical role in the management of aggressive behavior and insomnia in patients hospitalized with psychiatric illness.

Seasons and depression: the influence of cigarette smoking.

The seasonality of depressive illness has been documented since antiquity. A review of 611 patients, who were consecutively admitted to the adult inpatient psychiatric unit of a mid-Michigan general hospital, examined the influence of cigarette smoking and psychiatric diagnosis upon the seasonal variation of admissions. Among the smokers, admissions for depressive disorders (n = 151) peaked in the springtime (z = 2.1, p < .05) and declined in summer. Admissions for the nonsmokers failed to demonstrate a substantial seasonal rhythm. Admissions for smokers and nonsmokers in other diagnostic groups did not show any seasonal variation. These findings parallel numerous studies regarding the influence of seasons upon rates of hospitalization for depressive disorder, and completed suicide. Therapeutic implications related to the bidirectional relationship between cigarette smoking and depression are discussed.

The cost of antidepressant overdose.

Ninety percent of suicide attempts referred to a general hospital are by self-poisoning. Among women, drug overdose is the commonest means of suicide. In a retrospective naturalistic review of 200 patients who were treated in the Critical Care Unit of a general hospital following medication overdose, 12% were antidepressant overdoses. The mean duration of hospital stay for overdose with tricyclic antidepressants (TCA) was more than double that for overdose with selective serotonin reuptake inhibitors (SSRI) (7 vs 3 days; z = 2.20, p < 0.05). The dollar cost of hospital treatment for patients who overdosed on TCAs was four times greater than that for patients who overdosed on SSRIs ($22,923 vs $5,379; z = 2.30, p < 0.05). The tricyclic compounds clearly have a price advantage over more recently introduced antidepressant agents fluoxetine, sertraline, paroxetine, venlafaxine, and bupropion. The apparent cost advantage of prescribing a less expensive drug may be nullified by the cost associated with adverse consequences.

Relationship between concurrent substance abuse in psychiatric patients and neuroleptic dosage.

The use of a structured diagnostic interview (The Schedule for Affective Disorders and Schizophrenia) with 58 consecutively admitted general adult psychiatric patients revealed that 62.1% of them abused alcohol and 58.6% had a substance use disorder. The drug abusers did not differ significantly from the nonabusers on mean psychoticism (Brief Psychiatric Rating Scale) scores. However, they received higher doses of antipsychotic agents (mean daily dose 1022 mg CPZ EQ (SD = 614) vs 609 mg CPZ EQ (SD = 481); z = 2.58, p < .01) to achieve stabilization. The clinical implications of this finding are discussed.

Seasons and bipolar disorder.

The records of 377 bipolar disorder patients who were consecutively admitted to a general inpatient psychiatric unit in mid-Michigan over a 6-year period were examined. The seasonal variation of hospitalization, total sleep time, thyroid stimulating hormone, creatinine levels, lithium dosage and serum levels, aggressive behavior, and treatment outcome were analyzed. Among men, the admission rate peaked in the springtime. Women demonstrated a bimodal season distribution, with peak admission rates in spring and fall. Aggressive behavior in both men and women peaked in the spring (z = 2.50, p < 0.05). Men maintained on lithium achieved higher serum lithium levels during the summer months. These findings parallel previous reports regarding the influence of seasons upon bipolar disorder. The therapeutic implications related to seasonality and mania are discussed.

A review of the utilization of sedative-hypnotic drugs in a general hospital.

A retrospective review of 493 patients treated during a single month in a general hospital in mid-Michigan revealed that a majority (84.2%) of them received prescriptions for sedative-hypnotic drugs. These were p.r.n. in 66% of cases and routine prescriptions in the remainder. Prescriptions were equally distributed across the specialties: internal medicine 15%, surgery 23%, family practice 19%, psychiatry 22%, and OB/GYN 20%. Flurazepam was the most frequently prescribed drug (48.4%), followed by triazolam (24.6%) and temazepam (12.2%). Actual utilization rates were highest among psychiatric patients (85%) and lowest in obstetrics (33%). The therapeutic rationale for prescribing sedative hypnotic agents to hospitalized patients is discussed.

Sex differences in bipolar affective disorder: neuroleptic dosage variance.

Bipolar affective disorder in men and women often differs in prevalence, age of onset, phenomenology, and longitudinal course. A study of 112 bipolar patients, comprising 72 women and 40 men who were discharged from an acute inpatient setting on antipsychotic drugs, is reported. Higher mean discharge neuroleptic doses were prescribed to men below the age of 40 and to women above the age of 40. The clinical implications of higher dosing patterns are discussed.

Yawning as a complication of electroconvulsive therapy and concurrent neuroleptic withdrawal.

Among the various reported neuropsychological effects of electroconvulsive therapy are amnesia, delirium, peripheral neuropathy, headaches, and seizures. A case history is presented that describes a previously unreported neurological sequela: the development of intractable yawning during a course of electroconvulsive therapy. Neuropathophysiological mechanisms possibly relating to this phenomenon are discussed.

Suppression of tardive dyskinesia with amoxapine: case report.

Evidence of the neuroleptic potency of amoxapine is rapidly accumulating. A case history is presented which complements the growing literature in this area. A depressed patient with persistent orofacial dyskinesia was placed on amoxapine and experienced a suppression of her involuntary movements. The therapeutic implications of this observation are discussed.