Stuart C. Yudofsky

Textbook of psychiatry.

The Editors proclaim their goal as “...to assemble a textbook that presents, as comprehensively as is possible in a single volume, the clinically relevant topics in psychiatry. . .We have thus endeavored to present a psychiatric text that may be used in a fashion similar to that of several other standard textbooks in other fields such as internal medicine, general surgery, pediatrics, endocrinology, and pharmacology: a text that is not only useful as a standard educational reference for psychiatrists and psychiatry residents, but that is also purchased and used extensively by medical students, residents, and more advanced professionals from other disciplines and specialties”.

RELIABILITY AND VALIDITY OF THE OVERT AGITATION SEVERITY SCALE IN ADULT PSYCHIATRIC INPATIENTS

An instrument, that validly and reliably identifies and measures agitation is required to evaluate environmental modifications, interpersonal strategies, psychopharmacological interventions, directed toward managing these commonly occurring and highly-disabling emotions and behavior. The conceptualization of agitation on a continuum from anxiety to aggression provides a practical framework for guiding clinical practice toward the early identification and intervention of agitation. The results of this study established the reliability and validity of the Overt Agitation Severity Scale (OASS) in measuring agitation severity in young adult psychiatric inpatients based on objectifiable vocalizations and motoric upper and lower body behaviors. The OASS differs from other agitation scales in its ability to capture both the intensity and frequency of observable behavioral manifestations of agitation, as opposed to subjective interpretations and a diffuse range of symptoms and problem behaviors.

Association of serum cholesterol and triglyceride levels with agitation and cognitive function in a geropsychiatry unit

Several studies have reported an association between aggression and cholesterol levels. The purpose of this study was to investigate the relationship of serum cholesterol and triglyceride levels with aggression and cognitive function in elderly inpatients. One hundred ten patients consecutively admitted to the Geriatric Psychiatry inpatient unit at Houstons Veterans Affairs Hospital received comprehensive evaluations by a multidisciplinary team. Fasting serum cholesterol and triglyceride levels were obtained within 3 days of admission. In addition, two geriatric psychiatrists administered the Mini-Mental State Examination (MMSE) and the Cohen-Mansfield Agitation Inventory (CMAI). Correlation coefficients were calculated between lipid levels, CMAI total and subscale scores, and MMSE scores. Multiple linear-regression analyses were done to further investigate the relation between lipid concentrations and various confounders. We found no significant correlation between serum triglyceride levels and MMSE, CMAI total, and CMAI factor scores. In addition, we found a significant positive correlation between serum cholesterol levels and physical nonaggressive behavior, and a significant negative correlation between serum cholesterol levels and MMSE scores. We found no relationship between aggressive behavior and serum cholesterol or triglyceride levels. However, an association between high cholesterol levels and agitation exists, which may be mediated by the association between high cholesterol levels and impaired cognition.

Psychopharmacological approaches to the patient with affective and psychotic features

Affective and psychotic disorders may occur after traumatic brain injury. These symptoms may arise from the direct effect of the trauma on the brain, from the side effects or withdrawal from drugs and medications, and from the emotional reaction to the event. Patients with TBI are especially sensitive to the side effects of drugs that act on the central nervous system. When appropriate guidelines are followed, psychopharmacological intervention alleviates these symptoms, enhances rehabilitation, and avoids impairment of arousal and attention.

Pharmacologic treatment of neuropsychiatric disorders.

Emotional and cognitive symptomatologies, such as depression, mania, lability of mood and affect, psychosis, impaired arousal, anxiety, and irritability and aggression often occur in neurologic disorders. These neuropsychiatric syndromes significantly impair functioning and efforts at rehabilitation. Patients with brain damage are especially sensitive to the side effects of medication. When appropriate guidelines are followed, psychopharmacologic intervention alleviates these symptoms, enhances rehabilitation, and avoids impairment of arousal and cognition.

Dexedrine/Dexedrine Spansules (dextroamphetamine)

Dexedrine (dextroamphetamine) and Dexedrine Spansules (dextroamphetamine sustained-release capsules) are psychostimulants, or better known as stimulants. Dexedrine is used primarily in treating attentiondeficit/hyperactivity disorder (ADHD) and narcolepsy, a condition characterized by daytime somnolence in which the patient periodically falls into a deep sleep during the day. Narcolepsy is a disorder of the sleep–wake control mechanisms within the brain that interferes with both daytime wakefulness and nighttime sleep. The use of a medication for its approved indication is called its labeled use. In clinical practice, however, physicians often prescribe medications for unlabeled (“off-label”) uses when published clinical studies, case reports, or their own clinical experiences support the efficacy and safety of these medications for these unapproved indications. Dexedrine is often used to augment antidepressants in treating refractory depression. For patients with chronic treatment-resistant depression, for example, Dexedrine in combination with antidepressants can provide symptomatic relief and improvement beyond that experienced with antidepressants alone. In numerous clinical studies and decades of clinical experience, Dexedrine has clearly demonstrated improvement in outcome for children with ADHD. Dexedrine increases the child’s ability to concentrate, extends attention span, and decreases hyperactivity. Adults with ADHD also benefit from therapy with Dexedrine. Dexedrine helps them concentrate and remain focused on their tasks, increases their attention span, and decreases impulsivity and hyperactivity.