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Agitation is a common neuropsychiatric symptom (NPS) in the early and middle stages of Alzheimer's disease (AD) dementia, which is difficult to treat and causes much distress. The U.S. Food and Drug Administration (U.S. FDA) issued black box warnings against the use of antipsychotics in dementia in 2005 and 2008 due to the increased risk of morbidity and mortality, resulting in the reduction in antipsychotic use for treating dementia-related NPS and spurring the quest for safer and more effective pharmacological options. The data favoring the use of citalopram for treating agitation in AD dementia is particularly compelling, and this may be a class effect for all selective serotonin reuptake inhibitors. However, concerns about the cardiac side-effects of citalopram have limited its widespread use for this indication. In this article, available efficacy and safety data for the use of citalopram and escitalopram in treating agitation in AD dementia is reviewed, using a composite case to illustrate key points. Practical recommendations are made to facilitate the use of these medications in routine clinical practice, risk mitigation strategies are discussed and salient issues for future clinical research are emphasized.  相似文献   
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目的分析精神科医生、精神分裂症患者及其家属对知情同意具体程序的态度,以指导今后知情同意的实施。方法所有样本均来自中南大学湘雅二医院,共计55名患者,46名家属,61名医生。采用知情同意态度问卷,来调查精神科医生、精神分裂症患者及其家属对知情同意具体程序的态度。结果患者、家属、精神科医生非参数检验结果表明,共计有17项条目存在显著性差异。比如条目4“签写一份接受医疗服务的知情同意书,其目的是”,67.4%的家属,59.2%的患者,90.2%的医生选择第3项“既保护医生又保护患者”,仅21.7%的家属,26.5%的患者,1.6%的医生选择第2项“保护患者”。结论目前精神分裂症患者、家属以及精神科医生对知情同意具体程序的态度存在明显差异。  相似文献   
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目的:了解我国精神科高级职称医生对双相抑郁治疗过程中抗抑郁药物与躁狂转化的认识。方法:自编与双相抑郁治疗有关的因素评价表让全国各地的专科医生根据自己的经验进行选择。结果:调查信回收率70%,有56位医生回答了全部问题。医生认为,使用抗抑郁药物(94.6%)、联合多种抗抑郁药物(64.2%)、不同时应用心境稳定剂(50.9%)与双相抑郁治疗过程中引发躁狂有关。结论:我国精神科高级职称医生对双相抑郁治疗过程中药物引起躁狂发作的认识比较全面。  相似文献   
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Magnesium is essential for the activation of many enzymes, and its plasma concentration in relation to that of calcium affects nerve transmission and muscle contraction. Magnesium deficiency occurs in conditions associated with impaired intestinal absorption or excessive urinary loss of insufficient intake, especially in those on intravenous therapy. In addition, alcoholism, parathyroid disorders, porphyria, and inappropriate secretion of antidiuretic hormone are also frequently associated with magnesium deficiency. Magnesium deficiency states may manifest in neurologic, cardiovascular, and psychiatric disorders. Dramatic occurrence of acute brain syndromes, in postoperative patients as well as in patients with burns associated with magnesium deficiency, have been noted. Magnesium deficiency has also been implicated in chronic brain syndromes, alcoholic states, depression, and schizophrenia. Another area of importance is the relationship of lithium treatment and magnesium deficiency. In this paper, the association between various psychopathologic states and lithium is reviewed.  相似文献   
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Objective

Surgeons and psychiatrists have been described as two contrary groups, the one healing by hands and the other by words. Empathy is needed in every physician–patient relationship. We tested whether (1) surgeons and psychiatrists show different levels of cognitive and emotional empathy; (2) measurements of cognitive and emotional empathy correlate with physician-specific empathy; and (3) gender, experience, and career choices are influencing factors.

Methods

56 surgeons and 50 psychiatrists participated. We measured empathy with the Jefferson Scale of Physician Empathy (JSPE), cognitive empathy with the Reading the Mind in the Eyes Test Revised (RME-R6), and emotional empathy with the Balanced Emotional Empathy Scale (BEES).

Results

Male psychiatrists scored significantly higher than that of male surgeons (118.0 ± 9.86 vs. 107.5 ± 13.84; p = 0.0006) in the JSPE. Analytically trained psychiatrists scored significantly higher in the JSPE than that of behaviorally trained psychiatrists (p = 0.024, F test, adjusted for gender). Both the RME and the BEES correlated positively with the JSPE.

Conclusion

Higher scores for empathy were found in male psychiatrists than in male surgeons.

Practice implications

Further research is needed to learn about the effects of general medical training on empathy.  相似文献   
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方华  王勇  赵敏 《医学教育》2013,(5):794-797
本文详细介绍了英国医学教育体系及其医师培训的模式.在结合我国精神科医师培训的特点及现状的情况下,借鉴英国专科医师培训的成功经验,提出了我国精神科医师培训模式的设想,并对建立我国精神科医师培训制度提出建议.  相似文献   
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ObjectivesAuto-experimentation, experimentation on oneself by oneself, is a relatively unknown practice, albeit one playing a central part in the origin of medical discoveries. The birth of psychopharmacology can be found within this history of auto-experimentation. Beyond the context of intermittent discoveries of chemical substance, the auto-experimentation by psychiatrists persists in an informal manner with psychotropic medications currently on the market. Nevertheless, this contemporary practice seems not to have been hitherto studied.Persons and methodTwenty-four French psychiatrists have been asked to answer a semi-structured interview, with the aim of discovering the motivations behind past auto-experimentation. This sample is not representative of the total population of French psychiatrists, but it is quite heterogeneous in age, gender and manner of practice for this exploratory research work.ResultsTwenty-three psychiatrists participated in the interview, and one refused. The various motivations leading to auto-experimentation amongst the psychiatrists are principally linked to attempts to better understand the effects of the psychotropic medications prescribed, chiefly their side effects. The usage of auto-experimentation can be facilitated by the curiosity of the psychiatrist, certain psychological functioning (“sensation-seeking” or linked to specific personality traits) and can conceal a secondary benefit attempt (an auto-therapeutic endeavour, a financial benefit during a clinical study, or even mimicking a psychic illness for a precise purpose). Fears, belief of uselessness or a denial of the question distance the psychiatrist from auto-experimentation. Lastly, collective factors such as folkloric or group elements and intergenerational dimensions influence the usage of this practice.ConclusionsDespite the variety in motivations and the obvious difference in psychotropic experience between the psychiatrists performing these experiments and the unwell patient, this practice questions our conceptions of psychotropic medications and mental illness. The epistemological foundations of our discipline are thusly tested, as is our relationship to knowledge and how we transmit it. The medical world's strong ambivalence to this relatively taboo practice deserves to be put into perspective with the current psychiatric model, which seeks to be scientific.  相似文献   
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