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What Promotes Joy
Published in Eve Shapiro, Joy in Medicine?, 2020
Something unique to me is that I love being part of a rich world that’s so different from the one I was raised in. That’s more fun for me than doing something that’s safe and familiar and stable—although it’s important to me, too, to have a piece of that. But I have a persistent restlessness that can be either a barrier or a source of energy depending on what I do with it. I want to have something to digest, to write about and talk through at the end of the day, to have a story to share, to stretch my experience of the world. I want to have absurd things happen and to laugh hysterically about them. I want to be surprised and humbled and out of my element. If I can have that in my life, it makes me happy. That means I’m going to put myself in situations like these. I am happy when I’m challenged.
Confusion and Terminal Restlessness
Published in Margaret O’Connor, Sanchia Aranda, Susie Wilkinson, Palliative Care Nursing, 2018
Terminal restlessness is variously termed ‘terminal agitation’, ‘agitated confusion’, or ‘agitated delirium’. It is arguably one of the least-understood conditions in palliative care, as is evidenced by the lack of specific literature on the subject before the 1990s. Terminal restlessness is marked by: (i) behavioural signs; and (ii) mental agitation. The behavioural signs associated with the physical restlessness include: (i) pulling at the bedclothes; (ii) frequent changes of position; and (iii) being unable to relax physically. The mental agitation is manifested by: (i) twitching; (ii) moaning; and (iii) calling out—often incoherently. Myoclonus (generalised involuntary muscle twitching) is common in terminal restlessness (Burke 1997). There is overwhelming anxiety, not amenable to reassurance (Barraclough 1997). Families find this agitated behaviour very distressing to witness. Unfortunately, the diagnosis is sometimes made retrospectively, following the death of the person.
Child and adolescent psychiatry
Published in Gideon Felton, Fast Revision for the MRCPsych CASC Exam, 2017
If, however, this behaviour is pervasive in a multitude of situations, then a diagnosis of hyperkinetic disorder needs to be explored. Hyperkinetic disorder typically results in the affected child being unable to focus or complete a task (e.g. a jigsaw puzzle). This behaviour becomes most obvious at school when they are in a structured organised situation. Other symptoms include restlessness, fidgeting and excessive noisiness in particular situations that require calmness (e.g. during mealtimes, when watching TV). This child may struggle to remain seated in these situations and may be accident-prone. He may eat poorly and have difficulty getting to sleep.
Switching to long-acting injectable antipsychotics: pharmacological considerations and practical approaches
Published in Expert Opinion on Pharmacotherapy, 2023
Mikkel Højlund, Christoph U. Correll
Generally, two options exist to prevent or counter potential rebound symptoms: i) slow down the switch, and ii) introduce transient, calming medications [21]. Slowing down the switch will ensure sufficient ongoing receptor occupancy to prevent symptoms as described in Table 1, minimizing the impact of dopaminergic, histaminergic, and/or cholinergic stimulation when switching from an antipsychotic with high affinity and antagonism to these receptors. Calming medications can alleviate the symptoms while plasma levels of the post-switch antipsychotic are increasing. Benzodiazepines are the most obvious choice to counter anxiety, agitation, akathisia/restlessness and psychosis, but other medications that, such as antihistamines and valproate can also be utilized. Beta-blockers might help if akathisia develops during the switch. Table 5 presents different corrective approaches and pharmacological aides to the management of rebound symptoms that may occur during pre-switch antipsychotic switching.
Pharmacological Treatment of Generalised Anxiety Disorder: Current Practice and Future Directions
Published in Expert Review of Neurotherapeutics, 2023
Harry A. Fagan, David S. Baldwin
Both classification systems describe a similar range of symptoms [4,5]. The DSM-5 emphasizes the presence of excessive anxiety and worry, which is difficult to control. Additional associated symptoms include restlessness, muscle tension, difficulties in concentration, the subjective feeling of one’s mind going blank, irritability, and sleep disturbance. The ICD-11 highlights the presence of general apprehensiveness (or ‘free-floating anxiety’) or excessive worry of negative events occurring in several different aspects of everyday life. Additional associated symptoms include restlessness, muscle tension, sympathetic autonomic overactivity, difficulties in concentration, irritability, and sleep disturbance. Both systems require symptoms to be present for more days than not for at least 6 months (DSM-5) or several months (ICD-11), and to result in some degree of functional impairment.
Development of a Pain Scoring System for Use in Sheep Surgically Implanted with Ventricular Assist Devices
Published in Journal of Investigative Surgery, 2019
Jenelle M. Izer, Rebecca A. LaFleur, William J. Weiss, Ronald P. Wilson
The aim of this study was to create a practical pain scoring system specific to sheep implanted with VADs, including a combination of subjective and objective means of assessment. Due to the unique housing environment of the sheep, it was not feasible to include an evaluation of flock behavior and locomotion as subjective measures in the scoring system. Alternatively, subjective measures include behavioral indices of pain specific to ruminants, such as bruxism, kicking at the abdomen, and stomping of feet, which were rated as either present or not present. Additional subjective measures include restlessness (present or not present), excessive vocalization (present or not present), mental status (normal or abnormal), posture (normal, lying with head/neck extended, laterally recumbent or hunched/guarding abdomen), and pain upon palpation of the surgical site (present or not present). Restlessness was determined by the individual evaluator and was defined as a frequent change in position and/or shifting back and forth multiple times over a brief period of time. Objective physiologic measurements include heart rate, respiratory rate (normal, >20% above normal, or > 50% above normal) and feed and water intake (normal or reduced). Postoperative heart and respiratory rates were compared to the baseline preoperative values of each individual sheep (Table 1), rather than using standardized reference values for comparison.