To compare the efficacy of antipsychotics (APs) for delirium treatment in patients with cancer, 27 patients treated with 1 of the 4 APs, haloperidol (HPD), risperidone (RIS), olanzapine (OLZ), and ...quetiapine (QTP), were divided into 2 groups: long half-life (T1/2; HPD, RIS, and OLZ) versus short T1/2 (QTP) or the multiacting receptor-targeted APs (MARTAs; OLZ and QTP) versus the non-MARTA (HPD and RIS). The symptom severity was evaluated by the memorial delirium rating scale (MDAS) on days 0, 3, and 7 following intervention. Significant improvements in total MDAS scores were found in all groups on day 3. However, on day 7, only the short T1/2 group and MARTA group showed significant improvement. Consideration of an AP’s pharmacological properties may be helpful for improving the outcomes of pharmacological delirium intervention in patients with cancer.
In order to realize the development of psychiatry in general hospitals without psychiatric wards, it is crucial to increase the importance of psychiatry through consultation liaison activities. It is ...also important to emphasize an educational and collaborative system that enriches the capacity of primary care teams. We need to attempt new projects, such as outpatient management, in order to cope with the annually increasing demand and the limited number of psychiatrists, and also in order to maintain our physical and mental health. Such attempts will make it possible for general hospital psychiatry to play a central role in the local medical community. We can build the attractive and sustainable status by such a system.
Copper deficiency (normal serum copper level: 78-136μg/dl) has been reported in patients with long-term enteral nutrition, caused by a copper deficit in enteral nutrition. Occasionally, this leads to ...anemia and leukopenia. We used Hersheys' pure cocoa that is rich in copper (content 3.8mg/cocoa 100g) for copper deficiency. A total of 86 (40 men and 46 women, mean age 69 years) patients on enteral nutrition were studied. The primary diseases were cerebral vascular disease in 71 patients, neurological disease in 5 and others in 10. Those who showed serum copper levels of 20μg/dl or less (N=8) were given 30-45g of cocoa (copper content 1.14-1.71mg) per day for about 40 days. Among them, two patients could not continue because of vomiting and diarrhea and were excluded from this study. Mean serum copper levels increased from 8.7±6.2 to 99.0±25.4μg/dl (N=6). Those who showed serum copper levels 20-77mg/dl (N=31) were given 10g of cocoa (copper content 0.38mg) per day for about 40 days. When mean serum copper levels increased from 50.5±19.3 to 89.0±12.9μg/dl with cocoa administration, anemia and neutropenia caused by copper deficiency showed a tendency to improve. After completing the study period, cocoa was reduced to 5g (copper content 0.19mg) per day in 23 patients. The mean serum copper levels increased from 90.7±10.4 to 100.6±17.1μg/dl for about 100 days. Recently, the amount of daily copper requirement for adults has been reported to be 1.28-2.5mg per day. We showed that 10g of cocoa (0.6mg total copper: 0.38mg in cocoa and 0.22mg in other nutrients) is sufficient to treat copper deficiency, and 5g of cocoa (0.37mg total copper: 0.19mg in cocoa and 0.18mg in other nutrients) is enough to maintain the normal level of serum copper in patients with long-term enteral nutrition.
We report two female patients who deteriorated to depressive-catatonic state after interepisode recovery from a hypomanic episode induced by corticosteroid treatment. Their symptoms developed during ...maintenance treatment with a low dose of prednisolone in Case 1 and after discontinuation of betamethasone in Case 2. Intravenous clomipramine successfully relieved their symptoms including reduction in contact and reactivity, immobility and mutism. These two patients showed no schizophrenic symptoms such as hallucinations and delusions. Corticosteroid-induced mood disorder can deteriorate into depressive stupor, severe depressive episode with catatonic features in DSM-IV. Clomipramine, a tricyclic antidepressant with relatively stronger serotonin reuptake inhibition, is one of the useful treatment options for corticosteroid-induced depression even in severe cases.
Purpose: We report successful treatment of a patient with delusions and hallucinations by using electroconvulsive therapy (ECT) at a palliative care unit (PCU). Case Report: A female patient in her ...thirties was diagnosed with recurrent ascending colon cancer and metastatic lung cancer. On the 18th day after admission to our PCU, she developed severe delusions and hallucinations with catatonia. She was unable to take medicines orally because of obstruction of the digestive tract. Further, standard treatment using intravenous haloperidol was ineffective. We repeatedly evaluated her psychiatric and somatic status and administered ECT under general anesthesia (midazolam, propofol, and suxamethonium chloride). The decision to administer ECT was made by the members of a multidisciplinary team. On the 1st day of ECT, delusions and hallucinations were markedly reduced. These symptoms disappeared after 4 courses of ECT for 3 days, and she returned to normal clinical status without demonstrable side effects. The levels of serum creatine phosphokinase and electrolytes were in normal range. Conclusion: ECT is a highly effective treatment for psychiatric disorders and can be administered to a special population of patients (for example, pregnant women, elderly patients, patients resistant to treatment, and patients in emergency). Our experience indicates that ECT is an effective and relatively safe procedure of choice for terminally ill cancer patients. Palliat Care Res 2011;6 (1): 336-339
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