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Degenerative Diseases of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
James A. Mastrianni, Elizabeth A. Harris
Behavioral manifestations are often difficult to treat. Some behaviors improve with initiation of an acetylcholinesterase inhibitor. Acute worsening of chronic behavioral issues may relate to an underlying medical condition and, as such, physical symptoms or iatrogenic factors should be sought out and corrected. Infection of either the bladder or lungs, for example, can cause a marked change in behavior in patients with AD. Overmedication, or the lack of administration of prescribed medications, might also produce new behavioral symptoms.
Phenytoin
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
When a breakthrough seizure occurs, blood levels should be obtained. If the PHT concentration is below those obtained after initiation of treatment, the patient has been noncompliant, or PHT clearance has been altered by comedication or an illness. Noncompliance is the most common cause of subtherapeutic PHT concentrations and failure of treatment (30). If the PHT concentration is in the previous range of values, a cause for the exacerbation of seizures must be investigated. Also, the dose should be increased. Usually, an increase from 300 mg of PHT/day to 400 mg in a person with levels of 10 to 15 pg/ml will result in toxicity. If available, one of the pharmacokinetic programs should be used for dose adjustment (31). Otherwise, a dose increase of 10 to 20% (30 or 60 mg) should be made, and levels checked in 3 to 6 weeks. If an increase in dose is prescribed without measuring levels, the possibility of overmedication is great because the patient probably was noncompliant, and now, after the frightening experience of a seizure, will become very compliant with the increased dose.
Psychological and Psychiatric Treatment of Chronic Pain in Geriatric Populations
Published in Andrea Kohn Maikovich-Fong, Handbook of Psychosocial Interventions for Chronic Pain, 2019
Luis Richter, Shruti Shah, Stephanie Wheeler
Prescribers must monitor a patient’s response to medications and adjust accordingly (AGS, 2009). It is important to know if the patient is taking the medication as prescribed, with careful assessment for overmedication, abuse, or undermedication. This can often be verified by obtaining information from the patient and family or caregivers, if possible.
Location of Power within Psychiatry: A Fifty-Year Journey as Represented in Film
Published in Issues in Mental Health Nursing, 2020
Lois Biggin Moylan, Ian Needham, Kevin McKenna, Jeanne Kimpel
Nurses were under strict orders to perform these interventions even when they felt moral distress in doing so. One author of this paper witnessed this as a student and was traumatized by the experience. Another situation depicted in this film was the overmedication of patients, which was common following the early discovery of neuroleptic antipsychotic psychiatric medications. The discovery of chlorpromazine in 1950 was a great breakthrough for the treatment of mental illness (psychosis), but it was often used in excess for behavioral control rather than its therapeutic effects (Braslow, 1998). The complete absence of professional nurses in this film reflects the lack of importance that was attributed to these health care providers. Decision-making related to patients was entirely the purview of the psychiatrist. All of the direct patient care is performed by attendants. Abusive use of coercive power, relating to the physician’s existing power of position (legitimate power), is demonstrated in the use of forced treatment against the will of the patient.
Going meta on metacognitive interventions
Published in Expert Review of Neurotherapeutics, 2018
Steffen Moritz, Paul H. Lysaker, Stefan G. Hofmann, Martin Hautzinger
It is important to keep in mind that despite the aforementioned similarities, CBT, Metacognitive Therapy, Metacognitive Training, and MERIT have a number of clear differences (e.g., CBT: exposure as a central element, disputation of Beckian emotional biases; Metacognitive Therapy: focus on dysfunctional coping mechanisms, especially worry/rumination and thought suppression; Metacognitive Training: ‘straightening’ disorder-specific cognitive distortions such as overconfidence or jumping to conclusions in psychosis). Applying the same label to all these orientations would create confusion. To be clear, we need to continue scientific debates about which treatment elements are most helpful and which treatment elements are not. Yet, despite conceptual differences, as scientists, we should be united in our efforts to disseminate and refine evidence-based treatments. We should also be happy for every patient who receives an evidence-based treatment, whether or not it is ‘our’ particular approach. Too many patients still do not receive any treatment or the treatment they do receive is ineffective or even potentially harmful (e.g., over-medication or the use of medication alone when psychotherapy or a combination of pharmaco- and psychotherapy is indicated). These practices should be seen as the real enemy.
Systematic review of preclinical, clinical, and post-marketing evidence of bupropion misuse potential
Published in The American Journal of Drug and Alcohol Abuse, 2019
Andrew C Naglich, E. Sherwood Brown, Bryon Adinoff
Speculation surrounding the real-world potential of bupropion to be misused was partially resolved with the publication of case reports and epidemiologic tracking data documenting intentional bupropion misuse in a variety of populations (47,48). Consistent with other estimations of bupropion misuse potential in human laboratory studies, a non-peer reviewed, industry-funded epidemiological analysis of Drug Abuse Warning Network (DAWN) data collected from 2004 to 2011 found visits with bupropion listed as an intoxicant that were coded as “overmedication” comprised a relatively small, but consistent, portion of all emergency room (ED) visits across the evaluated years (48). “Overmedication” in this context was considered by the authors of the study as a proxy for intentional misuse and was one of several mutually exclusive categories including “Suicide Attempt,” “Seeking Detox,” “Adverse Reaction,” “Overmedication,” “Accidental Ingestion,” and “Other” (48). The yearly incidence of all ED visits associated with bupropion and coded “overmedication” averaged 303 visits per year (range 207–350) associated with “overmedication” (48). For purposes of comparison, DAWN data reported caffeine-related ER visits resulting from non-medical use averaged 2,736 visits per year (range 1,876–4,567) and d-amphetamine-related ER visits resulting from non-medical use averaged 6,122 visits per year (range 2,303–11,327) across the same time-period and population. “Nonmedical Use” in the DAWN reports is analogous to “Overmedication” in the study by Bibeau and colleagues in that cases in the “Nonmedical Use” group excludes suicide attempts, patients seeking detox, adverse reactions, and accidental overdose (49).