Psychiatric inpatients' knowledge of medication at hospital discharge.

Results of a survey of 253 psychiatric inpatients on the day of discharge from a short-stay hospitalization indicated that more than half did not know the name and dosage of the psychiatric medications prescribed for them and why they were taking them, even though they had received both group and individual medication instruction during hospitalization. Sixty-eight percent of the patients knew the names of all their psychiatric medications, but only 53 percent knew when to take them. Sixty-three percent felt that they had some understanding of why the medications were prescribed, while 37 percent said they did not know. Younger, better-educated patients who had an affective illness (as opposed to schizophrenia) were more likely to have adequate knowledge of their medication regimen. Results suggest the need for more active forms of medication education, such as supervised self-administration in the final days of hospitalization.

The use of low-dose intranasal midazolam to treat panic disorder: a pilot study.

BACKGROUND: Drug therapy of panic disorder, despite the intermittent nature of the panic attack, requires daily administration of antidepressants, which are often not tolerated, or benzodiazepines, which can result in physical dependence and withdrawal. The use of rapidly acting, low-dose intranasal midazolam to prevent incipient panic suggested itself to us as a novel alternative treatment strategy. METHOD: We conducted a 6-week double-blind, placebo-controlled, crossover-design pilot study of the safety and efficacy of p.r.n. low-dose intranasal midazolam in five patients diagnosed with DSM-III-R panic disorder. RESULTS: One to two drops of midazolam (approximately 0.25 to 0.5 mg) was well tolerated and highly effective in preventing incipient panic attacks and in reducing the overall weekly frequency of attacks. CONCLUSION: Intermittent intranasal midazolam shows promise as a novel alternative treatment for panic, but a controlled study of its efficacy and safety (including abuse potential) must be conducted.

Suicide upon recovery from depression. A clinical note.

We present two cases of suicide upon recovery from severe depression. In both cases a hypomanic phase followed by a switch down into depression appeared to be the clinical context of the impulsive suicidal act. We offer a critique of the hypothesis that accounts for suicidality during early remission from depression in terms of "mobilization of energy."