Rates of antipsychotic polytherapy have risen dramatically over several decades and have been reported in all treatment settings in many different countries. In addition, rigorously controlled studies have found antipsychotic polytherapy increases side effects and cost without improving primary outcome measures. Improvements on secondary measures have been reported by a few studies. Without supporting data, the increasing rates of antipsychotic polytherapy are coming under increased scrutiny.
Psychiatric Advance Directives and Board Certified Psychiatric Pharmacists: An Opportunity for Patient Empowerment
In times of psychiatric crisis, the most vulnerable population, those with severe, often debilitating, mental illnesses, may be least able to advocate for their care and make their treatment preferences known. The psychiatric advance directive (PAD) is a transportable vehicle used to empower persons with a psychiatric disability to advocate for their treatment desires even when incapacitated during an acute exacerbation.
Elevated prolactin levels may be due to a variety of causes which include physiological factors, such as stress or lactation, prolactinomas, hypothalamic diseases, endocrine disorders, and medication.1 Medications frequently associated with elevated prolactin levels include antidepressants, antipsychotics, antihypertensive agents, estrogens, and peripheral dopamine antagonists.
Atypical antipsychotics have rapidly replaced conventional agents as first-line pharmacologic treatments for psychotic disorders. These drugs may represent an important advance in therapy for mental illnesses, due to a reduced risk of extrapyramidal side effects (EPS) and possible advantages in efficacy compared to conventional agents.
Sexual dysfunction has been reported to occur in approximately 30-70% of patients receiving antidepressant medications. The highest incidence of sexual dysfunction is seen primarily in patients receiving serotonin reuptake inhibitors (SSRIs) where up to 50-70% of these patients have been shown to have difficulties in sexual functioning. The occurrence of medication-associated sexual dysfunction increases the likelihood of medication non-compliance (or adherence) in patients, which may contribute to untreated depression and/or disease relapse. The goal of this review is to summarize and evaluate the current literature on the occurrence of antidepressant-associated sexual dysfunction as well as to assess the treatment options available for this side-effect.
Evidence for augmentation with atypical antipsychotics for treatment-resistant obsessive compulsive disorder (OCD) is limited. Published data is restricted to open label studies and few small double-blinded studies, mainly with risperidone, olanzapine and quetiapine.1 There is one open-label study with aripiprazole in patients who were not receiving pharmacotherapy for OCD.2 This is a report of the first known case of aripiprazole used as augmentation for treatment-resistant obsessive compulsive disorder.
Emergency room physicians, particularly in rural settings, may experience resource limitations, one of which may include follow-up verification of initial urine drug screen results. In this setting, versus the legal setting, confirming the results prior to clinical management or therapy initiation may not be possible. As our case demonstrates, venlafaxine may cause a false positive PCP assay irrespective of concentration or reagent. Increased awareness of this potential effect by all healthcare providers is encouraged, particularly when interpreting urine drug assay results on admissions of highly agitated developmentally disabled persons who may have speech articulation difficulties and/or staff unfamiliar with the patient.
Submitted 04/15/2005; Accepted 07/06/2005. Peer Reviewed by two reviewers.
Due to unique diagnostic and treatment issues, many distinctive clinical situations are encountered in treating psychiatric disorders in those with severe-profound developmental disability and comorbid psychopathology. This report reviews the effects of polypharmacotherapy on the measurable behavioral symptoms displayed by a person with severe mental retardation and an eventual diagnosis of rapid cycling bipolar disorder. The limited verbal skills entailed in this population require a different approach to diagnosis due to lack of useful verbal information exchange. Other obstacles encountered in arriving at a diagnosis and developing an effective treatment plan, including the matter of diagnostic overshadowing, are reviewed.
Urinary incontinence (UI) is an embarrassing and distressing adverse effect of antipsychotic agents. Untreated UI may even lead to noncompliance in distressed patients. The incidence of UI and enuresis may be underreported. Although UI associated with antipsychotic use has been recognized, the etiology and optimal treatment strategies have not been fully established. This article was written to review the published literature and to explore the reported treatment options.