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Conscious Level (conscious + level)
Selected AbstractsNeurological complications of psychiatric drugs: clinical features and management,HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue S1 2008Peter M. Haddad Abstract This paper reviews the main neurological complications of psychiatric drugs, in particular antipsychotics and antidepressants. Extrapyramidal syndromes include acute dystonia, parkinsonism, akathisia, tardive dyskinesia and tardive dystonia. Extrapyramidal symptoms (EPS) are less frequent with atypical than with conventional antipsychotics but remain common in clinical practice partly due to lack of screening by health professionals. Neuroleptic malignant syndrome (NMS) consists of severe muscle rigidity, pyrexia, change in conscious level and autonomic disturbance but partial forms also occur. NMS is particularly associated with the initiation and rapid increase in dose of high-potency antipsychotics but it has been reported with all the atypical antipsychotics and rarely with other drugs including antidepressants. Serotonin toxicity comprises altered mental state (agitation, excitement, confusion), neuromuscular hyperactivity (tremor, clonus, myoclonus, hyper-reflexia) and autonomic hyperactivity and occurs on a spectrum. Severe cases, termed serotonin syndrome, usually follow the co-prescription of drugs that increase serotonergic transmission by different pathways, for example a monoamine oxidase inhibitor (MAOI) and a selective serotonin reuptake inhibitor (SSRI). Most antipsychotics and antidepressants lower the seizure threshold and can cause seizures; the risk is greater with clozapine than with other atypical antipsychotics and greater with tricyclic antidepressants (TCAs) than with SSRIs. In randomised controlled trials in elderly patients with dementia atypical antipsychotics are associated with a higher risk of stroke and death than placebo. Cohort studies suggest that conventional drugs carry at least the same risk. Cessation of treatment with antipsychotics and antidepressants can lead to a wide range of discontinuation symptoms which include movement disorders and other neurological symptoms. Clinicians need to be familiar with strategies to reduce the risk of these adverse events and to manage them when they arise. Their occurrence needs to be balanced against the benefits of psychiatric drugs in terms of efficacy and improved quality of life in a range of disorders. Copyright © 2007 John Wiley & Sons, Ltd. [source] Infertile couples' experience of family stress while women are hospitalized for Ovarian Hyperstimulation Syndrome during infertility treatmentJOURNAL OF CLINICAL NURSING, Issue 4 2008Shiu-Neng Chang MS Aims and objectives., The aim of this study was to explore the essential structure of family stress among hospitalized women receiving infertility treatment with Ovarian Hyperstimulation Syndrome. Background., When hospitalization is necessary for infertile women with Ovarian Hyperstimulation Syndrome, they face health-illness transition stress and their families are traumatized by the pressure of hospitalization. Most literature on infertility treatment has dealt with the infertile women's physio-psychological reactions, the impact on the couples' relationships and the influence of social support on infertile couples. Design., A descriptive phenomenological design consistent with Husserl's philosophy. Methods., Ten married couples from a Taipei medical centre participated in the study. All the couples were receiving infertility treatment because the female partners were suffering from moderate or severe Ovarian Hyperstimulation Syndrome and this required hospitalized. An open in-depth interview technique encouraged parents to reflect on their experience, which raised their feelings to a conscious level. Data were analysed using Colaizzi's approach. Results., This study explored infertile women's experiences from the couples' perspectives and the results identify the overall stresses that the family face. Five themes emerged from the study, namely, the stress of ,carrying on the ancestral line', the psychological reactions of the couple, a disordering of family life, reorganization of family life and external family support. Conclusions., The results demonstrate that the experience of family stress involves impacts that range across the domains of individual, marital, family and social interactions and there is a need to cope with these when the wife is hospitalized for moderate to severe Ovarian Hyperstimulation Syndrome. Relevance to clinical practice., The findings indicated that nurses should provide infertile couples with family-centred perspectives that are related to Chinese cultural family values. Nurses should supply information on infertility treatment and assist couples to cope with their personal and family stress. [source] Simple bedside assessment of level of consciousness: comparison of two simple assessment scales with the Glasgow Coma scale,ANAESTHESIA, Issue 1 2004A. F. McNarry Summary Neurological assessment is an essential component of early warning scores used to identify seriously ill ward patients. We investigated how two simple scales (ACDU , Alert, Confused, Drowsy, Unresponsive; and AVPU , Alert, responds to Voice, responds to Pain, Unresponsive) compared to each other and also to the more complicated Glasgow Coma Scale (GCS). Neurosurgical nurses recorded patients' conscious level with each of the three scales. Over 7 months, 1020 analysable measurements were collected. Both simple scales identified distinct GCS ranges, although some overlap occurred (p < 0.001). Median GCS scores associated with AVPU were 15, 13, 8 and 6 and for ACDU were 15, 13, 10 and 6. The median values of ACDU were more evenly distributed than AVPU and may therefore be better at identifying early deteriorations in conscious level when they occur in critically ill ward patients. [source] | ||||||||||