Acute Psychiatric Management by Michael Robertson

By Michael Robertson

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A novel antipsychotic agent. New England Journal Medicine. 1991;324(11):746-54 and UK clozapine study group. The safety and efficacy of clozapine in severe treatment-resistant schizophrenic patients in the UK. British Journal Psych. 1993;150-54. 40. Kane J, Honigfield G, Singer J, et al. Clozapine for the treatment-resistant schizophrenic; results of a US multicenter trial. Psychopharmacol. 1989;99:560-63. 41. Lieberman JA, Safferman AZ, Pollack S, et al. Clinical effects of clozapine in chronic schizophrenia: response to treatment and predictors of outcome.

Efficacy of ECT Low-dose unilateral ECT has a response rate of 17%, compared to higher dose unilateral ECT, which has a response rate of 43%. Low dose and high-dose bilateral ECT has a response rate of 63-65%69. In the light of this, most clinicians have opted for simulus-dosing treatment protocols for ECT, in which a patient’s seizure threshold is determined empirically, using a titration method of lower charge stimuli, with subsequent treatments being ‘dosed’ at 2-3 times the established seizure threshold.

Once it has been determined that the underlying cause is sedation from medication, vital signs such as blood pressure, pulse, respiratory rate, oxygen saturations, temperature and Glasgow Coma Scale should be monitored every 10 minutes for 60 minutes, every 15 minutes for 30 minutes, every 30 minutes for 60 minutes then hourly for 4 hours or until awake. The Medical Officer should not leave the patient for at least 30 minutes and only if the patient could maintain their airway and whose vital signs are stable.

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