Trends in prescribing of psychotropic medications for inpatient adolescents in Israel: a 10 years retrospective analysis.

We examined the trends in prescribing psychotropic drugs to children and adolescents within an inpatients adolescent psychiatric ward in Israel. Data of 414 subjects, ranging from 12- to 22-year-old, covering the years 1997, 2002 and 2007, was examined retrospectively. Analyzed variables included the number and type of drug prescriptions per patient at discharge, the subjects' age at discharge and the number of diagnoses per patient at discharge. Analysis of variance (ANOVA) with repeated measures was used to evaluate changes between the three calendar years, along the 10-year study period, while Pearson χ(2) test was performed for categorical variables. Over the study period the mean age at discharge decreased significantly, by about a year and a half, the mean number of diagnoses increased significantly, from 1.6 to 2.4 diagnoses per patient and the total number of drugs prescribed at discharge increased significantly from 1.48 to 1.93 per patient. Overall, the number of patients who were prescribed mood stabilizers increased by 14%, those who were prescribed antidepressants increased by almost 24%, almost 16% in antipsychotics prescriptions and 51.5% in prescriptions of atypical antipsychotics. Typical antipsychotic prescriptions decreased by 35.5% and accordingly, the number of patients who were prescribed agents for the treatment of extra-pyramidal side effects decreased by almost 24%. Due to a low number of inpatients with attention deficit and hyperactivity disorder (ADHD), no significant statistical conclusion could be drawn regarding trends in psychostimulant prescriptions. Our findings agree with other published studies from the last two decades. The growing use of psychotropic agents in children and adolescents merit a continuous concern with regard to their effects on the developing brain and impact on quality of life and to authorizing these drugs for use in specific young age subgroups.

Neuroleptic malignant syndrome during abrupt reduction of neuroleptic treatment.

Development of neuroleptic malignant syndrome (NMS) following discontinuation of high-dose and high-potency neuroleptic agents is described. This case, although rare and atypical, should alert clinicians to consider the possibility of NMS as a complication of abrupt neuroleptic drug withdrawal. It is suggested that dopaminergic imbalance, as opposed to excessive dopaminergic blockade, may also play a role in the precipitation of NMS.

Alternative work scheduling for professional social workers.

The authors present some practical evidence that the changing nature of today's work force requires innovative alternatives to traditional scheduling based on the 9 to 5, five-day workweek. They support alternative work scheduling (AWS) as an updated and promising approach. Described is their experience with a two-year AWS pilot project in the Social Work Service of an urban medical center, with their focus upon the processes of negotiating, programming, and implementing the concepts of "flex-time," "compressed workweek," and "job sharing." Informal assessment indicates strongly positive responses from the participating social workers, other members of the health care team, and the consumers of the services.