Search results

Delirium, or acute confusional syndrome, is a set of symptoms whose care involves not only psychiatry, but also many other medical specialties. Being as how the syndrome is caused by multiple factors, it is important to recognize each risk factor affecting the patient in order to anticipate and prevent it. In case of diagnosis, identifying and treating the root cause that triggered is important, given that it has a high rate of comorbidity and an elevated cost of medical care. We describe a case where a patient with hypothyroidism began suffering from delirium due to an abrupt discontinuation of levothyroxine treatment. Previously, the patient was seemingly healthy. After the medical treatment was interrupted, sensory processing and behavior were altered, and symptoms fluctuated, for a short period of time, showing disorientation and memory and language impairment.

Clozapine is often considered the gold standard for the treatment of schizophrenia. Clinical guidelines suggest a gradual titration over 2 weeks to reduce the risks of adverse events such as seizures, hypotension, agranulocytosis, and myocarditis. The slow titration often delays time to therapeutic response. This raises the question of whether, in some patients, it may be safe to use a more rapid clozapine titration. The following case illustrates the potential risks associated with the use of multiple antipsychotics and rapid cloza-pine titration. We present the case of a young man with schizophrenia who developed life threatening neuroleptic malignant syndrome (NMS) during rapid clozapine titration and treatment with multiple antipsychotics. We were unable to find another case in the literature of NMS associated with rapid clozapine titration. This case is meant to urge clinicians to carefully evaluate the risks and benefits of rapid clozapine titration, and to encourage researchers to further evaluate the safety of rapid clozapine titration. Rapid clozapine titration has implications for decreasing health care costs associated with prolonged hospitalizations, and decreasing the emotional suffering associated with uncontrolled symptoms of psychosis. Clozapine is considered the most effective antipsychotic available thus efforts should focus on developing strategies that would allow for safest and most efficient use of clozapine to encourage its utilization for treatment resistance schizophrenia.

The purpose of the study is to assess the differential impact of gender and cancer sites on mental burden across different types of cancer and control patients.

The paper is based on a primary survey undertaken in 2015–2016 of 600 cancer and 200 control patients across five hospitals of Nepal. The data was analyzed using propensity score matching methods and treatment effect weighting estimators.

The authors find that of all the types of patients covered under this study, cervical cancer patients suffered from a greater intensity of anxiety and lack of functional wellbeing. On an average, all other female, male cancer patients, and control patients experience significantly lower intensity of mental burden in the range of 1.83, 2.63 and 3.31, respectively when compared to patients of cervical cancer. The results are robust across all the four treatment effect estimators and through all the measures of mental burden. The implications of suffering from cervical cancer, as a unique gynecological cancer was studied in-depth. An effect size analysis pointed out to the dysfunctional familial relationship as additional causes of concern for cervical cancer patients.

An important finding that emerged is that female cancer patients especially those who have cervical cancer should be given special attention because they appear to be the most vulnerable group. Further work is needed to delineate the reasons behind a cervical cancer patient facing higher amount of stress.

The purpose of this study is to evaluate the prescribing pattern of proton pump inhibitors (PPIs) in patients visiting the outpatient general medical clinic in a Tertiary Care Teaching Hospital.

A hospital-based cross-sectional study was conducted in 419 patients aged ≥18 years, visiting the outpatient general medicine clinic of a tertiary hospital and prescribed with at least one PPI, from July to September 2016 using a purposive sampling technique. Descriptive statistics were performed using IBM-SPSS 20.0 (IBM Corporation, Armonk, NY, USA).

Patients were mostly less than 30 years (30.78%) and female (58.95%). Pantoprazole was the most frequently prescribed PPIs (57.04%). The majority of PPIs were prescribed for acid peptic disorder (APD) (33.65%), followed by non-steroidal anti-inflammatory drugs (NSAIDs) prophylaxis (30.79%). Most of the PPIs were prescribed for twice-daily administration (68.26%). Nearly one-fourth (21.72%) of the patients presented with at least one additional medical condition, and almost all (99%) patients were receiving at least one additional drug along with PPIs.

The study suggests that PPIs are frequently prescribed and their use has been extended to other conditions that in fact do not require acid anti-secretory therapy. Result has highlighted the need for an interdisciplinary collaboration between pharmacists and medical professionals for the rational use of PPIs and promotion of PPIs prescription from the National List of Essential Medicines.

The purpose of this paper is to explore the reasons for the discontinuation of sports sponsor–sponsee relationships and categorize them. Despite the negative outcomes of a sponsorship dissolution, research on this topic is rather scarce.

The paper relies on an analysis of 24 historical cases and 19 in-depth interviews focusing on the Dutch soccer league. Several sponsorship disruptors are identified and clustered into four categories.

The four categories for sponsorship dissolution are the following: sponsor-related factors, sponsee-related factors, inter-relational factors and external factors. In total, ten sponsorship disruptors are identified: insufficient value creation, objectives achieved, sports results, signal to society, exclusivity, negativity, personal relationship, changed marketing strategy, financial situation and legislation and regulation.

This study primarily investigates soccer sponsorship cases. Future research could investigate other sponsorship areas, which could yield different reasons for sponsorship termination.

Practitioners are advised to view the sponsorship relationship as a strategic alliance, rather than a resource, from the beginning of the sponsorship. A solid relational framework is needed, which is built around the elements of trust, commitment and collaborative communication. If such a foundation does not exist or has eroded, the sponsorship relationship is fragile and can be endangered by various factors.

This study uses inductive reasoning to devise a framework that enables sponsees to anticipate when sponsors are likely to discontinue their sponsorship such that the sponsees can take actions accordingly. Apart from validating existing reasons for sponsorship dissolution, this research also presents novel and previously undiscovered sponsorship disruptors.

Haloperidol is a first-generation antipsychotic butyrophenone that is lipophilic, readily absorbed, and extensively metabolized in the liver. The occurrence of elevated liver enzymes with haloperidol is reported to be 2.4% with cases generally occurring in the setting of chronic use. In this case, we present a patient who developed elevated liver enzymes 1-2 days after starting haloperidol treatment on two separate occasions and in the context of negative hepatic viral and autoimmune serology. Liver enzymes consistently had alanine transaminase > aspartate transaminase and peaked at 288 U/L prior to discontinuation of the medication. The patient was taken off haloperidol after serology resulted and clozapine regimen started. He was able to tolerate clozapine well with recovery of his transaminitis and psychiatric stabilization.

Neuroleptic non-compliance remains a serious challenge for the treatment of psychosis. Non-compliance is predominantly attributed to side effects, lack of illness insight, reduced well-being or poor therapeutic alliance. However, other still neglected factors may also play a role. Further, little is known about whether psychiatric patients without psychosis who are increasingly prescribed neuroleptics differ in terms of medication compliance or about reasons for non-compliance by psychosis patients. As direct questioning is notoriously prone to social desirability biases, we conducted an anonymous survey. After a strict selection process blind to results, 95 psychiatric patients were retained for the final analyses (69 participants with a presumed diagnosis of schizophrenia psychosis, 26 without psychosis). Self-reported neuroleptic non-compliance was more prevalent in psychosis patients than non-psychosis patients. Apart from side effects and illness insight, main reasons for non-compliance in both groups were forgetfulness, distrust in therapist, and no subjective need for treatment. Other notable reasons were stigma and advice of relatives/acquaintances against neuroleptic medication. Gain from illness was a reason for non-compliance in 11-18% of the psychosis patients. Only 9% of all patients reported no side effects and full compliance and at the same time acknowledged that neuroleptics worked well for them. While pills were preferred over depot injections by the majority of patients, depot was judged as an alternative by a substantial subgroup. Although many patients acknowledge the need and benefits of neuroleptic medication, non-compliance was the norm rather than the exception in our samples.

Clinical manifestations of drug-induced skin reactions include a wide range of symptoms, from mild drug-induced exanthemas to dangerous and life-threatening generalized systematic reactions. Drug-induced skin reactions to psychotropic medication are usually associated with antiepileptic drugs. However, a significant role can be assigned to selective serotonin reuptake inhibitors. We report a case of a female patient, who after approximately one month therapy with escitalopram developed a bilateral ankle edema, which resolved completely within the first week following its discontinuation. Although serious complications are rare, clinicians should be aware of severe skin complications in patients treated with antidepressants, which necessitate careful clinical monitoring and management. Individualization of pharmacotherapy is crucial, together with regular evaluation of safety and tolerance of the treatment.