Managementul terapeutic al sindromului catatonic

Catatonic states occur in the context of a wide variety of both psychiatric and medical conditions. Since 1992 benzodiazepines represent a first-line treatment in catatonia, because they offer several advantages: a wide margin of safety, a rapid response, and they are easily administered. Other treatments include atypical antipsychotics, antiglutamatergic drugs, lithium. Lorazepam and other GABA-A promoters (benzodiazepines, zolpidem) increase GABA activity as their mechanism of action.Starile catatonice apar în diverse afectiuni psihiatrice sau medicale. Benzodiazepinele reprezinta prima linie de tratament în catatonie din începând 1992, datorita unei serii de avantaje: profil de siguranta bun, raspuns rapid, usor de administrat. Alte tipuri de tratatment includ antipsihotice atipice, agenti antiglutaminergici, litiu, Lorazepam si alti stimulanti GABA-A (benzodiazepine, zolpidem) actioneaza prin cresterea activitatii GABA ergice

Choice of antipsychotic treatment by European psychiatry trainees: are decisions based on evidence?

Background: Little is known about the factors influencing treatment choice in psychosis, the majority of this work being conducted with specialists (consultant) in psychiatry. We sought to examine trainees' choices of treatment for psychosis if they had to prescribe it for themselves, their patients, and factors influencing decision-making. Methods: Cross-sectional, semi-structured questionnaire-based study. Results: Of the 726 respondents (response rate = 66%), the majority chose second-generation antipsychotics (SGAs) if they had to prescribe it for themselves (n = 530, 93%) or for their patients (n = 546, 94%). The main factor influencing choice was perceived efficacy, 84.8% (n = 475) of trainees stating this was the most important factor for the patient, and 77.8% (n = 404) stating this was the most important factor for their own treatment. Trainees with knowledge of trials questioning use of SGAs (CATIE, CUtLASS, TEOSS) were more likely to choose second-generation antipsychotics than those without knowledge of these trials (chi(2) = 3.943; p = 0.047; O.R. = 2.11; 95% C.I. = 1.0-4.48). Regarding psychotherapy, cognitive behavioural therapy (CBT) was the most popular choice for self (33.1%; n = 240) and patient (30.9%; n = 224). Trainees were significantly more likely to prefer some form of psychotherapy for themselves rather than patients (chi(2) = 9.98; p < 0,002; O.R. = 1.54; 95% CIs = 1.18-2.0). Conclusions: Trainees are more likely to choose second-generation antipsychotic medication for patients and themselves. Despite being aware of evidence that suggests otherwise, they predominantly base these choices on perceived efficacy

Satisfaction with psychiatric in-patient care as rated by patients at discharge from hospitals in 11 countries

Purpose: There is disregard in the scientific literature for the evaluation of psychiatric in-patient care as rated directly by patients. In this context, we aimed to explore satisfaction of people treated in mental health in-patient facilities. The project was a part of the Young Psychiatrist Program by the Association for the Improvement of Mental Health Programmes. Methods: This is an international multicentre cross-sectional study conducted in 25 hospitals across 11 countries. The research team at each study site approached a consecutive target sample of 30 discharged patients to measure their satisfaction using the five-item study-specific questionnaire. Individual and institution level correlates of ‘low satisfaction’ were examined by comparisons of binary and multivariate associations in multilevel regression models. Results: A final study sample consisted of 673 participants. Total satisfaction scores were highly skewed towards the upper end of the scale, with a median total score of 44 (interquartile range 38–48) out of 50. After taking clustering into account, the only independent correlates of low satisfaction were schizophrenia diagnosis and low psychiatrist to patient ratio. Conclusion: Further studies on patients’ satisfaction should additionally pay attention to treatment expectations formed by the previous experience of treatment, service-related knowledge, stigma and patients’ disempowerment, and power imbalance.</p