精神科住院患者易患肠梗阻的相关因素及护理

目的：探究精神科住院患者发生肠梗阻的相关因素及护理策略。方法针对本院精神科接受治疗的肠梗阻患者50例进行回顾性调查,分析其发生肠梗阻的相关因素。结果精神科住院患者易患肠梗阻主要与抗精神病药物副作用、精神病症状、环境改变、机体对抗精神病药敏感性与耐受性以及长期禁食或饮食不当有关。结论医护人员应加强工作责任心,细致观察病情,及早发现并处理抗精神病药的副作用。另外,对患者进行健康知识教育,给予综合护理,适当药物或食物干预促进肠蠕动,均能降低肠梗阻的发生率。     

精神病患者便秘原因分析及护理对策

目的探讨住院精神病患者便秘发生原因及护理对策。方法对132例住院精神病患者发生便秘的相关因素进行回顾性分析,并制定相应的干预措施。结果住院精神病患者便秘发生率为63.64%;发生原因主要有抗精神病药物的副作用,饮食因素,活动量少,以及精神症状等。结论住院精神病患者便秘发生率较高,医护人员应提高业务素质及责任心,提倡合理用药,指导患者饮食及多活动,以预防便秘,一旦发生便秘,应及时处理。     

奥氮平在精神疾病治疗中的应用

在精神科领域，已经广泛公认，抗精神病药物是通过阻断D２受体而发挥疗效，但这一性质也带来了频繁出现的临床治疗学上所不希望看到的锥体外系症状（EPS），给患者和家属带来了极大的烦恼。非典型抗精神病药物氯氮平的问世，对精神科治疗学造成了新的冲击，其在药理学、生物化学和临床特征上与其它抗精神病药物均有不同，具有抗精神病作用而不产生锥体外系副作用，且既能治疗精神分裂症的阳性症状也能治疗阴性症状，对部分难治性的病例亦能显示疗效，由于其有上述作用，故从２０世纪８０年代起氯氮平广泛应用于精神科临床达１０余年，在使…     

氯氮平的临床应用

持久的阴性症状对精神分裂症患者的心理社会和职业功能康复的不良影响,愈来愈受到人们的重视。氮氨平是一种典型抗精神病药物,以非常有效的抗精神病作用和减少锥体外系副作用的为特征而问世,其独特作用是治疗难治性患者及改善阴性症状。本文将综述氮氨平在国外的应用情况。     

精神障碍患者噎食护理干预进展

噎食是精神科常见的意外,徐巧英曾报道其发生率为0.41%。平均每例患者每住院56.32个月便发生1次噎食。如果救治护理方法得当,可使患者很快恢复,如果救治不及时或措施不当,可导致窒息死亡。现将精神障碍患者噎食原因、临床表现、护理干预及应急处理综述如下。1噎食原因1.1药物因素精神患者长期服用抗精神病药物,如酚噻嗪类、硫杂蒽类等,三环类抗抑郁药、镇静催眠药、抗焦虑药等,容易导致噎食。陈予君的研究发现服用典型抗精神病药物及剂量较大者易发生锥体外系不良反应,出现急性肌张力障     

住院精神病患者体重指数影响因素分析

目的了解影响住院精神病患者体重指数的相关因素，为临床干预提供依据。方法检测住院≥1a的精神病患者的体重指数，并与服药种类、年龄、性别、病程、住院时间等因素进行相关分析。结果患者长期服用抗精神病药物体重指数≥25的发生率为53．61％，未服用抗精神病药物者体重指数≥25的发生率为26．92％，体重指数与患者性别、年龄、病程、住院时间、服用抗精神病药物种类等因素显著相关。与病程呈负相关（P〈0.01），与年龄呈正相关（P〈0.05），与服用氯氮平呈正相关（P〈0.05），女性超重多于男性。结论住院精神病患者的体重指数与患者性别、年龄、病程、住院时间、服用抗精神病药物种类等因素显著相关。     

精神科病人噎食窒息的相关因素分析

目的研究精神科病人噎食窒息的危险因素及急救措施。方法对2001年4月～2006年4月我院精神科病房发生噎食窒息病人的临床资料进行分析。结果发生噎食窒息病人儿例12例次中，死亡5例，抢救成功6例。11例病人均存在进食过急、过快情况；其中，除2例年老体弱病人及3例新入院、首次应用抗精神病药物的病人非大剂量用药外，余6例均为应用大剂量、高效价抗精神病药物或多种药物联合应用者；9例病人均存在不同程度的锥体外系副反应。11病人中，6例7例次采用HEMLICH法抢救，除1例因抢救过迟死亡外，余5例6例次均抢救成功。结论精神科病人噎食窒息与进食过急、速度过快，年老体弱，抗精神病药物所致锥体外系副反应等有关。HEMLICH法是抢救噎食窒息的一种有效措施。     

精神分裂症患者病程、年龄、职业、收入等因素与抗精神病药物需求的相关性

目的:了解精神分裂症患者病程、年龄、职业、收入等因素与使用抗精神病药物的感受和需求的相关性。方法:对100例患者进行精神健康教育计划-抗精神病药物问卷调查,分别按照不同病程(≤8年和>8年)和不同经济收入水平(≤500元/月和>500元/月)分组,比较各组间的差异。结果:目前服用传统抗精神病药物的患者占61%,69%对目前服用的药物不满意,48%的患者无力支付新一代药物的费用;病程≤8年组年龄较小,有工作者较少,无收入或低收入(400元/月以下)者较多;病程>8年组药物副作用发生率较高,对当前服用的抗精神病药物不满意率达80%;收入≤500元组失业几近一半,药物副作用较多,并因而影响到自己缺乏独立的信心。结论:精神分裂症患者医疗支付能力有限,对目前占主导地位的传统药物不满意,病程短者年龄更小,收入更低,而低收入者的药物副作用更常见。     

精神病性症状及药物锥体外系副作用对平稳期精神分裂症患者主观生活质量的影响

目的调查中国精神科门诊精神分裂症患者的主观生活质量,并探讨精神病性症状和药物锥体外系副作用和生活质量的关系。方法对符合研究条件的198例平稳期精神分裂症患者的精神病性症状、药物锥体外系副作用和其主观生活质量进行标准化测量。对数据进行多元逐步回归分析。结果药物锥体外系副作用对于患者生活质量的躯体领域有显著影响;阳性症状和焦虑症状对于患者生活质量的心理领域、社会领域和环境领域有重要影响。结论对于处于平稳期的精神分裂症患者,有效控制其阳性症状、焦虑症状和锥体外系副作用,能够改善患者的主观生活质量。     

自拟“解毒汤”治疗抗精神病药所致锥体外系副反应

在精神科临床中,抗精神病药物所致的副反应较为常见,锥体外系副反应是常见的一种中枢神经系统副反应,其发生率占用药病人的20％-50％。应用抗胆碱能药物或抗组织胺类药物能取得一定效果,但疗效不甚满意。笔者在验方的基础上,通过临     

Extrapyramidal symptoms are serious side-effects of antipsychotic and other drugs.

Antipsychotic medications commonly produce extrapyramidal symptoms as side effects. The extrapyramidal symptoms include acute dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome. Extrapyramidal symptoms are caused by dopamine blockade or depletion in the basal ganglia; this lack of dopamine often mimics idiopathic pathologies of the extrapyramidal system. Less recognized is that extrapyramidal symptoms are also associated with certain non-antipsychotic agents, including some antidepressants, lithium, various anticonvulsants, antiemetics and, rarely, oral-contraceptive agents. Extrapyramidal symptoms caused by these agents are indistinguishable from neuroleptic-induced extrapyramidal symptoms. Clinicians must be able to recognize these side effects and be able to determine the antipsychotic-induced and non-antipsychotic causes of extrapyramidal symptoms.     

Side effects and its countermeasures of antidepressant

We reviewed the side effects of antidepressants. Tricyclic antidepressants(TCAs) are associated with a higher frequency of adverse events than those of SSRIs and SNRIs, particularly with respect to anticholinergic-like effects(dry mouth, constipation, and blurred vision), delirium, and cardiovascular adverse events. On the other hand, SSRIs have some special side effects that include nausea, sexual dysfunction, and extrapyramidal symptoms. With regard to milnacipran, a member of the SNRI family, dysuria occurs at a higher frequency than with TCAs or SSRIs. When side effects occur, clinicians give patients symptomatic treatment or substitute the drugs that cause the adverse effects with other antidepressants that have different pharmacological effects.     

Newer antipsychotic agents: Impact on quality of life and alternative applications

The introduction of the first antipsychotic drugs in the 1950s revolutionized treatment of mentally ill patients. Patients could be treated in the community and not confined to psychiatric institutions. However, these conventional neuroleptic agents were not ideal. Although effective for the positive symptoms of schizophrenia, they had little effect on the negative symptoms. They also had distressing side effects including extrapyramidal symptoms, anticholinergic effects, and sedation that caused many patients to discontinue treatment. In the late 1980s the first newer antipsychotic (clozapine) became available. Newer antipsychotics, which antagonize both the dopamine and serotonin receptors, are effective for both the positive and negative symptoms of psychoses and are less likely than conventional neuroleptics to cause extrapyramidal symptoms at recommended doses. Thus the newer antipsychotics may offer patients an improved quality of life while reducing costs. Clozapine is effective in up to 40% of treatment-refractory patients and may be useful in patients with mood disorders. Risperidone may be beneficial in some treatment-refractory patients, but results in patients with mood disorders are mixed. Further study is required to explore fully all possible applications of the newer antipsychotic drugs.     

Relationship between improvements of subjective well-being and depressive symptoms during acute treatment of schizophrenia with atypical antipsychotics

What is known and Objective: It has been suggested that atypical antipsychotics may exert beneficial effects on subjective well‐being as well as depressive symptoms in schizophrenia. However, the relationship between the two remains to be clarified. The authors examined the relationship between subjective well‐being and depressive symptoms across the course of acute treatment with atypical antipsychotics in patients with schizophrenia. Methods: Thirty‐five inpatients with schizophrenia were examined for subjective well‐being, psychopathology, and extrapyramidal side effects before and 8 weeks after the initiation of new treatment with atypical antipsychotics. Results and Discussion: Significant improvement was observed in subjective well‐being, psychotic symptoms, and depressive symptoms. No change was observed in the severity of extrapyramidal side effect. The subjective well‐being score had significant negative correlations with depressive symptom score both at baseline and at week 8. The mean change in subjective well‐being score was significantly correlated with that in depressive symptom score. The severity of depressive symptoms at baseline was significantly correlated with the subsequent change in subjective well‐being score and the change in depressive symptom score was the only predictor of change in subjective well‐being score. What is new and Conclusion: Depressive symptoms were significantly associated with subjective well‐being in patients with schizophrenia and may moderate the acute effects of atypical antipsychotic treatment on subjective well‐being. Further investigations are necessary to fully define the place of depressive symptoms in the conceptualization of subjective well‐being in schizophrenia and the optimal use of atypical antipsychotics.     

Medically unexplained symptoms: how often and why are they missed?

We assessed risk factors affecting the provisional diagnosis of medically unexplained symptoms made by physicians in new patients, in 526 clinical encounters. Comparisons were made between the doctor's initial assessments regarding the nature of symptoms, and the final diagnosis. Physicians were more likely to err on the side of diagnosing the symptoms as medically explained rather than unexplained. When physicians perceived the interaction with the patient to be positive, they were more likely to make a provisional diagnosis that the symptoms were explained. Conversely, a negative perception of the interaction was associated with an increased likelihood of viewing symptoms as medically unexplained. Physicians should be aware of the effect of their own perceptions on their diagnostic behaviour.     

Haloperidol complications in burn patients

Neuropsychiatric complications are commonly seen in major burn patients. Haloperidol is frequently used to treat severe psychopathic behavior. We have noted severe muscle rigidity-an extrapyramidal side effect of the agent-in a number of burn patients. Haloperidol causes a relative imbalance of dopaminergic and cholinergic neuronal activity in the basal ganglia with a relative increase in cholinergic activity being responsible for EPS. The burn patient may be more prone to extrapyramidal symptoms because of increased sensitivity of skeletal muscle neuromuscular junctions to acetylcholine after thermal injury.     

Extrapyramidal effects of acute organophosphate poisoning

Background: There is limited information on extrapyramidal symptoms in acute organophosphate (OP) poisoning. We describe the course and outcome of severely poisoned patients who develop extrapyramidal manifestations. Methods: In this prospective observational study, spanning 8 months (Apr–Nov 2013) adult patients (>18 years) admitted with OP poisoning were enrolled. Patients on anti-psychotic therapy, those refusing consent or presenting with co-ingestions were excluded. Treatment included atropine and supportive care (e.g. ventilation and inotropes as indicated); oximes were not administered. The presence of rigidity, tremors, dystonia and chorea were assessed daily till discharge using modifications of the Unified Parkinson’s Disease rating scale and the Tremor rating scale. The presence of extrapyramidal manifestations was correlated with length of ventilation and hospital stay and mortality. Results: Of the 77 patients admitted with OP poisoning, 32 were enrolled; 17 (53.1%) developed extrapyramidal manifestations which included rigidity (94.1%), tremors (58.8%) and dystonia (58.8%). None developed chorea. The median (inter-quartile range) time of symptom onset was 8 (5–11) days; extrapyramidal features resolved in 11 (6–17) days. The median duration of intensive care stay in patients not developing extrapyramidal symptoms was 6 (2–8) days, indicating that most of these patients had recovered even before symptom onset in patients who developed extrapyramidal manifestations. Overall, 27/32 (84%) were ventilated. Hospital mortality was 6.25% (2/32). When compared with patients not developing extrapyramidal signs, those with extrapyramidal manifestations had significantly prolonged ventilation (5 versus 16 median days; p?=?0.001) and hospitalization (8 versus 21 days; p?<?0.001), reduced ventilator-free days (23 versus 12 days; p?=?0.023) and increased infections (p?=?0.03). The need for ventilation and mortality were not significantly different (p?>?0.6). Extrapyramidal symptoms were not observed in non-OP poisoned patients with prolonged ICU stay. Conclusion: In this small series of acute OP poisoning, extrapyramidal manifestations were common after 1 week of intensive care but self-limiting. They are significantly associated with longer duration of ventilation and hospital stay.     

Serotonin syndrome caused by selective serotonin reuptake-inhibitors-metoclopramide interaction

OBJECTIVE: To report 2 cases of serotonin syndrome with serious extrapyramidal movement disorders occurring when metoclopramide was coadministered with sertraline or venlafaxine. CASE SUMMARY: A 72-year-old white woman was treated with sertraline for depression for 18 months and was then admitted to the hospital with a fractured tibia. She was administered metoclopramide because of nausea and, within 2 hours, developed agitation, dysarthria, diaphoresis, and a movement disorder. These symptoms recurred following 2 subsequent administrations of metoclopramide. Treatment with diazepam led to resolution of symptoms within 6 hours, and there was no recurrence at 6 weeks' follow-up. A 32-year-old white woman with major depression was treated with venlafaxine for 3 years. She was admitted following a fall and, after being given metoclopramide, developed movement disorder and a period of unresponsiveness. After a second dose of metoclopramide, these symptoms recurred and were associated with confusion, agitation, fever, diaphoresis, tachypnea, tachycardia, and hypertension. She improved with administration of diazepam, but needed repetition of this treatment over the next 16 hours. Symptoms resolved within 2 days, and she continued venlafaxine with no further adverse effects. DISCUSSION: Both cases met Stembach's criteria for serotonin syndrome and had serious extrapyramidal movement disorders. The possible pathophysiologic mechanisms for the adverse reactions include a single-drug effect, a pharmacodynamic interaction, and a pharmacokinetic interaction. We believe that a pharmacodynamic interaction is most likely. CONCLUSIONS: Clinicians should be aware of a risk of serotonin syndrome with serious extrapyramidal reactions in patients receiving sertraline or venlafaxine when metoclopramide is coadministered even in a single, conventional dose.     

Severe agitation following deep brain stimulation for parkinsonism

The use of deep brain stimulation has become increasingly common for the treatment of movement disorders, including Parkinson disease. Although deep brain stimulation is generally very successful in alleviating the extrapyramidal symptoms of Parkinson disease, side effects can occur. This case report describes a patient presenting to the emergency department in a state of extreme aggression 3 days after a change in the parameters of his bilateral subthalamic nucleus stimulator. We review the complications of deep brain stimulation relevant to the emergency physician and provide some practical information on stimulator adjustment in an emergency.     

A case of risperidone-induced hypothermia

Risperidone is one of the second-generation antipsychotics (SGAs). Use of SGAs or so-called atypical antipsychotics is becoming more frequent because they are more efficacious and safer than typical antipsychotics. This is due to their ability to occupy some other receptors as well as dopamine type 2 (D(2)) receptors in the brain. Risperidone has more affinity for serotonin type 2 (5-HT(2)) than for D(2) receptors. This accounts for its better treatment of negative symptoms of schizophrenia and fewer extrapyramidal side effects when compared with typical antipsychotics. Common side effects associated with risperidone include extrapyramidal symptoms, dizziness, nausea, weight gain, sleep disturbance, and sexual dysfunction. We describe here a case of risperidone-induced hypothermia. Body temperature is regulated by the preoptic anterior hypothalamus with involvement of dopamine, serotonin, norepinephrine, and alpha-adrenergic receptors. Experimental data suggest that stimulation of 5-HT(2) and dopamine receptors can increase the body temperature. Additional clinical evidence indicates potent antagonists of 5-HT(2) are more likely to cause hypothermia. Risperidone has higher potency for occupying 5-HT(2) than D(2) receptors.