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C Harrowerwilson - One of the best experts on this subject based on the ideXlab platform.

  • psychiatric intensive care in Acute Psychosis
    International Clinical Psychopharmacology, 1996
    Co-Authors: C E Hyde, C Harrowerwilson
    Abstract:

    We have reviewed the development of psychiatric intensive care, focusing on organizational factors and the causes of psychiatric violence, suggesting guidelines for rapid tranquillization. The economics of running a psychiatric intensive care unit were subjected to an analysis of fixed, semi-fixed and variable costs. Variable costs (treatment and patient numbers) were shown to be more open to manipulation and possible cost savings.

J Nicolai - One of the best experts on this subject based on the ideXlab platform.

  • pearls oy sters electroconvulsive therapy in anti nmda receptor encephalitis
    Neurology, 2010
    Co-Authors: H M H Braakman, V M P Moershornikx, B M G Arts, R M M Hupperts, J Nicolai
    Abstract:

    The clinical picture of anti-NMDA receptor (NMDAR) encephalitis is highly characteristic; the presence of NMDAR antibodies confirms the diagnosis. With its poor diagnostic criteria, encephalitis lethargica (EL) is a descriptive term for a melting pot of symptoms that likely represent multiple distinct disorders. Sporadic EL is a diagnosis of exclusion, only to be made after appropriate exclusion of anti-NMDAR encephalitis and other (auto)immune phenomena. NMDAR are ligand-gated cation channels with crucial roles in synaptic transmission and plasticity. The receptors are heteromers of NR1 subunits that bind glycine and NR2 subunits that bind glutamate.1 NMDA receptors are expressed on neurons throughout the brain; their highest densities are found in the amygdala, hypothalamus, prefrontal cortex, and hippocampus. Overactivity of NMDA receptors is a proposed underlying mechanism for epilepsy, dementia, and stroke, whereas low activity produces symptoms of schizophrenia.1 Antibodies against NR1-NR2 heteromers can result in a characteristic neuropsychiatric syndrome, anti-NMDAR encephalitis.2 Its characteristic clinical presentation resembles Acute Psychosis, with catatonia or, less frequently, memory deficits, followed by a rapid decline in the level of consciousness, central hypoventilation, seizures, involuntary movements, and autonomic instability. Although this syndrome was described recently,3 the ensuing report of numerous cases suggests that this is not a rare disorder.2 Anti-NMDAR encephalitis is a potentially fatal condition, although, if recognized timely, good treatment options exist. We present a case to illustrate that anti-NMDAR encephalitis should be considered in patients with Acute Psychosis, and that electroconvulsive therapy possibly adds an effective treatment option. A previously healthy 47-year-old man reported to the outpatient department. After an upper respiratory tract infection, he had persisting malaise and excessive sweating. Over a 3-week period, he developed derealization, intense anxiety, and eventually auditory hallucinations consisting of various kinds of music. Neurologic examination and brain CT revealed no abnormalities, including no …

Keith K Abe - One of the best experts on this subject based on the ideXlab platform.

  • a rapidly fatal case of anti nmda receptor encephalitis due to Acute brain edema and herniation
    Neurology, 2019
    Co-Authors: Stefan Mammele, Karen Thompson, Keith K Abe
    Abstract:

    Anti-NMDA receptor encephalitis (NMDARE) was described in 2005 as a syndrome of Acute Psychosis followed by progressive encephalopathy. Later, it was found to be a paraneoplastic process occurring in young women with teratomas.1 Today, it is recognized as one of the most common nonviral causes of encephalitis overall. In children, the disorder is less commonly associated with malignancy,2 and presents with personality changes, behavioral problems, seizures, dyskinesia, and speech problems.2,3 The condition is often treatment-responsive; however, it can infrequently progress to death after weeks or months despite treatment.4 Mortality is generally lower in children5 and we are not aware of a report of NMDARE that progressed to death within a few days.

C E Hyde - One of the best experts on this subject based on the ideXlab platform.

  • psychiatric intensive care in Acute Psychosis
    International Clinical Psychopharmacology, 1996
    Co-Authors: C E Hyde, C Harrowerwilson
    Abstract:

    We have reviewed the development of psychiatric intensive care, focusing on organizational factors and the causes of psychiatric violence, suggesting guidelines for rapid tranquillization. The economics of running a psychiatric intensive care unit were subjected to an analysis of fixed, semi-fixed and variable costs. Variable costs (treatment and patient numbers) were shown to be more open to manipulation and possible cost savings.

Fiona Macmillan - One of the best experts on this subject based on the ideXlab platform.

  • cognitive therapy and recovery from Acute Psychosis a controlled trial ii impact on recovery time
    British Journal of Psychiatry, 1996
    Co-Authors: Val Drury, Max Birchwood, Ray Cochrane, Fiona Macmillan
    Abstract:

    BACKGROUND A trial of CT in Acute Psychosis conducted by the authors has shown a significant impact on the rate and degree of recovery of positive symptoms, the focus of the intervention. This paper seeks to determine whether these effects generalise to other features of Acute Psychosis including dysphoria, insight and "low level' psychotic thinking which were not directly targeted. METHOD Measures of dysphoria, insight and psychotic thinking were taken over a six-month period following presentation for Acute Psychosis. Using survival analysis, time to recovery from Psychosis using three definitions of increasing stringency was compared between the CT and control group. RESULTS CT was associated with a 25-50% reduction in recovery time depending on the definition used. CONCLUSION The impact of the CT intervention extended beyond positive symptoms to include insight, dysphoria and "low level' psychotic thinking. Nevertheless this kind of "clinical' recovery required a median of 20 weeks to complete. Implications for clinical models of Acute care are discussed.

  • cognitive therapy and recovery from Acute Psychosis a controlled trial i impact on psychotic symptoms
    British Journal of Psychiatry, 1996
    Co-Authors: Val Drury, Max Birchwood, Ray Cochrane, Fiona Macmillan
    Abstract:

    BACKGROUND The application of cognitive therapy (CT) to Psychosis is currently being developed in the UK. This paper reports a trial of CT in Acute Psychosis with the objective of hastening the resolution of positive symptoms and reducing residual symptoms. METHOD Of 117 patients with Acute non-affective Psychosis, 69 satisfied inclusion criteria and 40 proceeded to stratified randomisation. The experimental intervention involving individual and group CT was compared with a group receiving matched hours of therapist input providing structured activities and informal support; routine pharmacotherapy was provided by clinicians blind to group allocation. Patients were monitored weekly using self-report and mental state assessments during admission and over the subsequent nine months. RESULTS Both groups showed a decline in positive symptoms but this was more marked in the CT group (P < 0.001). At 9 months 5% of the CT group, v.56% of the control group, showed moderate or severe residual symptoms. CONCLUSION CT appears to be a potent adjunct to pharmacotherapy and standard care for Acute Psychosis. Issues concerning internal and external validity of the study and opportunities for further research are discussed.