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Legal Eagle Eye Newsletter for the Nursing Profession - Combative patient: jury rules hospital staff not liable

admin — Sat, 03 Jan 2009 15:36:03 +0000

The seventy-nine year-old patient was admitted to the hospital’s intensive care unit for diabetic ketoacidosis.
The next evening she removed her monitor hook-ups, got out of bed and insisted that she would be leaving. Three nurses put her back to bed.
A few hours later her behavior became outright combative. Multiple staff members had to intervene. During the struggle the patient’s arm got caught between the mattress and the side rail.
One of the nurses lowered the bed rail to release her arm, but her arm and both legs were broken. After surgery the patient died a week later from her injuries
The family filed suit against the hospital in the Supreme Court, New York County, New York.

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No Haldol Given After First Episode of Confusion
The jury apparently discounted the family’s lawyer’s argument that Haldol should have been given when the patient first exhibited signs of confusion.
Instead, the jury accepted the hospital’s assertion that the first episode of mere confusion did not justify a chemical restraint. Nor would that episode necessarily lead staff to anticipate a full-blown combative episode would follow in which the elderly patient, suffering from advanced osteoporosis, would be badly injured. Estate of Klein v. North Shore Univ. Hosp., 2007 WL 1247192 (Sup. Ct. New York Co., New York, March 29, 2007).
COPYRIGHT 2007 Legal Eagle Eye Newsletter for the Nursing Profession
COPYRIGHT 2008 Gale, Cengage Learning

Newsweek - Long Shot

admin — Thu, 01 Jan 2009 12:21:02 +0000

As jury selection in the Andrea Yates trial wrapped up this week, the Houston mother accused of drowning her five children seemed at ease. She smiled, waved and mouthed “I love you” to her mother and mother-in-law when they left the courtroom.

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It’s a far cry from the near-catatonic demeanor she showed on the morning of June 20 when she was led in handcuffs away from the family’s Clear Lake home, where police found her dead children, ages 6 months to 7 years. With the help of Haldol, an antipsychotic drug, and psychiatric treatment at the Harris County Jail, Yates’s health has improved over the last several months, relatives say. “She still has a lot of confusion,” her brother, Andrew Kennedy, tells NEWSWEEK. “But she has a good sense of humor.” He says she recently joked, “Does Rusty ever keep his mouth shut?” referring to a series of …

Read the full article with a Free Trial at MyWire.

Southern Review, The - Haldol

admin — Mon, 29 Dec 2008 00:06:03 +0000

I’ll wear a long-sleeve shirt with cuffs
for protection–never restrain
an escalated girl alone–since the night
the Haldol wore so thin
she sputtered saliva and flung her weight
against each lock on the ward
I’d bolted, tight as the door of seclusion,
which only opens out
so she can’t kick it shut and trap us in.
That night her teeth chewed the skin up
and down my arms, leaving
ragged welts and contusions the doctors
in Emergency merely stitched
with scars. Now the pulse of each ambulance
sends me deeper into what
fluorescent light refracts, the tick and jump

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of dayroom walls. Now another
new foster father hugs the girl, whose posture
we’ve perfected over years with straitjackets,
dorsal horn of her spinal cord
so medicated he can’t imagine bandages
like mine might ever wrap
his arms. So today I’ll remind her how to slip
her arms willingly into the satin
sleeves of a warm coat, I’ll watch her
button it tight as the jaws
that clenched, the human bite that won’t let go.
COPYRIGHT 1998 Louisiana State University
COPYRIGHT 2008 Gale, Cengage Learning

Clinical Psychiatry News - Quetiapine rivals lithium, haloperidol

admin — Sat, 27 Dec 2008 16:06:02 +0000

SAN Francisco - Quetiapine monotherapy for bipolar I mania is as effective as lithium or haloperidol–and with markedly fewer side effects, Martin W Jones, Ph.D., said at the annual meeting of the American Psychiatric Association.
He reported on a pooled analysis of two double-blind phase III clinical trials involving 604 patients with a manic episode of bipolar I disorder who were randomized to 12 weeks of quetiapine (Seroquel), placebo, lithium, or haloperidol (Haldol).
The results were used by AstraZeneca Pharmaceuticals in its recent filing for a new indication for quetiapine as monotherapy or adjunctive therapy for acute mania associated with bipolar depression.

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That application remains under review by the Food and Drug Administration. Quetiapine is currently indicated only for treatment of adult schizophrenia, noted Dr. Jones of AstraZeneca in Wilmington, Del.
The 12-week studies were completed by 60.8% of patients randomized to the atypical antipsychotic and 38.9% on placebo.
Beginning on day 4, quetiapine-treated patients experienced significantly greater improvement than those on placebo.
COPYRIGHT 2003 International Medical News Group
COPYRIGHT 2008 Gale, Cengage Learning

Internal Medicine News - Haloperidol may raise risk of heart arrhythmia

admin — Sun, 21 Dec 2008 12:56:04 +0000

Patients taking the antipsychotic drug haloperidol may be at increased risk for heart rhythm abnormalities, according to a Food and Drug Administration alert.
Revised labeling on the drug, marketed as Haldol, Haldol decanoate, and Haldol lactate, includes a cardiovascular subsection explaining the increased risk for prolonging the QT interval. The risk for arrhythmia appears to be greater when the drug is given in doses above the recommended amounts, or when it is given intravenously. The FDA advises clinicians to review the cardiac histories of patients who take haloperidol.

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For more information, contact the FDA by visiting www.fda.gov/medwatch/safety/2007/safety07.htm#Haloperidol.
COPYRIGHT 2008 International Medical News Group
COPYRIGHT 2008 Gale, Cengage Learning

Bipolar Disorder

admin — Tue, 16 Dec 2008 01:36:02 +0000

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person’s mood, energy, and their ability to function. It is an illness that affects thoughts, feelings, perceptions and behavior and is distinguished from Major Depressive Disorder by the presence of manic or hypomanic episodes. It can cause dramatic mood swings from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between.
Bipolar disorder is a chronic and generally life-long condition with recurring episodes of mania and depression that can last from several days to months that often begin in adolescence or early adulthood, and occasionally even in children. Most scientists now agree that there isn’t a single cause for bipolar disorder rather, many factors act together to produce the illness.
It is classified according to symptom severity as Bipolar Disorder I, Bipolar Disorder II, and Cyclothymic Disorder. Bipolar Disorder Type I is usually characterized by at least one manic episode, with or without major depression. It involves episodes of severe mood swings,from mania to depression and is the classic manic-depressive form of the illness as well as the most severe type.
Bipolar II disorder is usually a milder form, involving milder episodes of hypomania that alternate with depression. Some people never develop severe mania but instead experience milder episodes of hypomania that alternate with depression.
When four or more episodes of illness occur within a 12-month period, a person has rapid-cycling bipolar disorder.
Bipolar disorder will typically develop in late adolescence or early adulthood. In children or teens it can be difficult to distinguish from other problems such as attention-deficit hyperactivity disorder (ADHD), conduct disorder, oppositional defiant disorder, and depression. It can also manifests in late life as well. Bipolar disorder may appear to be a problem other than mental illness - alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships for instance.
Bipolar disorder affects more than one in forty American adults and affects men and women equally. Bipolar disorder often runs in families, and recent studies suggest a genetic component to the illness.
Different from the normal ups and downs that everyone can go through, the symptoms of bipolar disorder are severe. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives. Most people can achieve substantial stabilization of their mood swings and related symptoms with proper treatment. Between episodes, many people with are free of symptoms, but as much as one-third of people have some residual symptoms.
Treatment, in disabling bipolar disorder, is with mood stabilizers (classically, the lithium salts) that balance the manic and depressive states experienced by patients. Treatment and maintenance of this disorder is necessary throughout a person’s life once bipolar disorder has been diagnosed. Treatments may include medication, talk therapy, and/or support groups.
The following medications may be used to treat bipolar disorder (many patients are treated with a combination of two or more of these medications):
Lithium
A mood stabilizer, often used as initial treatment (helps prevent manic and depressive episodes from returning)
Valproate (Depakote), carbamazepine (Tegretol), lamotrigine, topiramate
Antiseizure medications, also used as mood stabilizers instead or in combination with lithium.
Benzodiazepines, clonazepam (Klonopin) or lorazepam (Ativan)
Can be used to treat agitation or insomnia.
Zolpidem (Ambien)
Used to treat insomnia.
Antidepressants
Serotonin reuptake inhibitors or bupropion (Wellbutrin) can be used to treat depression.
Antipsychotic medications
Uused for acute manic or mixed episodes and maintenance treatment.
Classic antipsychotic medications (eg, haloperidol (Haldol)) are not often used because of risks of tardive dyskinesia (uncontrollable movements).
Atypical antipsychotic medications (eg, risperidone, olanzapine, aripiprazole, zisprasidone, and quetiapine) are more effective with less risk of tardive dyskinesia Treatment may need to be continued for prolonged periods or indefinitely, depending on the pattern of the illness, to prevent significant mood swings.
Treatment of depression may also include support groups, talk therapy or other strategies that you and your health care provider may want to try. Treatment should not be postponed, however, because of the risk of suicide and school failure.

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admin — Wed, 10 Dec 2008 14:56:05 +0000

Background: First-generation antipsychotics have been the treatment of choice for acute mania with or without psychosis. However, because these agents may cause severe side effects and may worsen depressive symptoms in patients with bipolar disorder, they have limited use in these patients. Second-generation antipsychotics developed over the past few years have proven to be effective in the treatment of acute mania in bipolar disorder. These medications cause fewer side effects than the first-generation agents, do not appear to induce depressive episodes, and may have some antidepressant effect. One recent study found that there is significant variation in practice patterns when treating acute mania in bipolar disorder. To answer concerns about the effectiveness and safety of second-generation antipsychotics for this indication, Scherk and colleagues performed a meta-analysis of published randomized controlled trials.

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The Study: The authors searched the PsiTri and Medline databases for published and unpublished randomized controlled trials evaluating the effectiveness of second-generation antipsychotics in the treatment of acute mania in bipolar disorder. (PsiTri registers controlled trials that compile the published studies for the mental health field from all Cochrane review groups.) The second-generation antipsychotics included aripiprazole (Abilify), clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), ziprasidone (Geodon), and zotepine (Zoleptil). The primary outcome extracted from the literature was the mean change in the Young Mania Rating Scale score or similar scale scores from baseline to end point. Other outcome measures were response rate, effectiveness criteria (e.g., rates of dropout because of side effects or lack of effect), weight gain, rate of somnolence, and extrapyramidal symptoms.
Results: Twenty-four studies met the inclusion criteria, with a total of 6,187 patients. The studies compared second-generation antipsychotics with placebo, mood stabilizers, placebo in addition to mood stabilizers, or haloperidol (Haldol). Second-generation antipsychotics were significantly more effective than placebo and had effectivity similar to that of mood stabilizers. Participants who received the combination of second-generation antipsychotic and mood stabilizers had better response than those who were treated with only a mood stabilizer. Response rates for second-generation antipsychotics and haloperidol were similar. With regard to side effects, some second-generation antipsychotics were associated with an increased risk of extrapyramidal symptoms and somnolence compared with placebo.
Conclusion: Published data suggest that second-generation antipsychotics in addition to mood stabilizers are the best treatment strategy for acute mania. This combination resulted in greater reduction in mania scores, better response rates, and fewer dropouts resulting from ineffective treatment.
KARL E. MILLER, MD
Source: Scherk H, et al. Second-generation antipsychotic agents in the treatment of acute mania. Arch Gen Psychiatry April 2007;64:442-55.
COPYRIGHT 2007 American Academy of Family Physicians
COPYRIGHT 2008 Gale, Cengage Learning

Schizophrenia Drug Face-Off: No Clear Winner

admin — Tue, 09 Dec 2008 06:51:02 +0000

Sept. 19, 2005 — Mental health experts say it wasn’t a horse race. That explains why there’s no clear winner from a major government study pitting a new generation of schizophrenia drugs against one another.
Zyprexa was the most effective of the drugs. But its greater number of side effects dims its first-place finish.
Meanwhile, a come-from-behind, second-place finish by Trilafon — a little-known old horse that nobody thought had a chance — may rescue the older generation of schizophrenia drugs from being put out to pasture.
Funded by the National Institute of Mental Health (NIMH), the five-year study enrolled 1,500 schizophrenic patients at 27 U.S. medical centers. Neither patients nor their doctors knew whether they were getting Zyprexa, Seroquel, Risperdal, Geodon, or the older Trilafon. Jeffrey A. Lieberman, MD, now director of the New York Psychiatric Institute, led the study while at the University of North Carolina in Chapel Hill.
“These drugs work, but have limitations: 74% of patients in the study elected to seek something better rather than stay on their assigned medication,” Lieberman said today at an NIMH news conference. “When it comes to treatment, the glass is only half full. We all want more efficacy and fewer side effects. But make no mistake: These drugs do work.”
The study findings appear in the Sept. 22 issue of The New England Journal of Medicine.
‘Traditional’ Drug vs. Newer ‘Atypical’ Drugs
Schizophrenia is a frightening mental illness afflicting 3.2 million Americans. Usually beginning at age 18 to 24, patients suffer hallucinations, delusions, and disordered thinking. There is no cure. But treatments can greatly reduce the intensity of symptoms.
“Fifty years ago we would have been talking about people institutionalized in state hospitals,” NIMH director Thomas R. Insel, MD, said at the news conference. “Then there came drugs, such as Thorazine and Haldol, which proved quite effective in reducing symptoms and the need for hospitalization.”
These traditional antipsychotic drugs can have devastating side effects resembling Parkinson’s disease: tremor, rigid muscles, and abnormal or restless movements.
About 12 years ago, the new generation of “atypical” antipsychotic drugs came along. These drugs were much less likely to cause Parkinson’s-like side effects. But they came with side effects of their own — extreme weight gain and an increased risk of type 2 diabetes Even so, 90% of schizophrenia prescriptions are for one of these six drugs.
Clinical trials show that the drugs work better than no drugs at all. But the trials never told doctors how the drugs would work relative to one another. That’s why the NIMH sponsored the trial, known as the Clinical Antipsychotic Trials of Intervention Effectiveness or CATIE.
The trial included Trilafon to represent the traditional antipsychotic drugs. It also included four other atypical antipsychotics. Clozaril was not included in the first phase of the trial because it will be tested as a second-line treatment for patients who switch from one of the original drugs in the trial. Those results will be reported later.

Autism Anxiety Overload

admin — Fri, 05 Dec 2008 07:01:06 +0000

The renowned autism expert Tony Atwood is fond of putting it this way: “Autism is anxiety looking for a target.” Autism and anxiety go hand-in-hand. Autism affects a person’s ability to communicate with others or to understand the world around him, and that’s bound to cause anxiety and panic sometimes.
Anxiety becomes even worse when there is a change in the autistic child’s routine. Even positive and “fun” changes, like a school field trip or a visit to the zoo, can increase anxiety and aggressive behaviors.
For parents, the best course of action is to anticipate upcoming changes and help your child prepare for them. Many parents find it helpful to use stories and pictures to prepare children for impending disruptions. If it’s a field trip to the zoo, for example, use pictures to show your child what he’ll see at the zoo, what the zoo will be like, and what sort of things to expect. Do this each day for three or four days prior to the trip. That way, when the trip actually happens, the child won’t be entirely out of his element, but will already understand and appreciate some of what will be happening.
Other changes in the routine are less enjoyable but still necessary. Getting a new teacher can be traumatic, as can moving to a new house. If at all possible, try to spread out the major changes. If you move to a new house, try to do it during the summer, so that your child won’t have to deal with the added anxiety of getting a new school and new teacher mid-year.
You can also introduce your child to the concept of “change” in a positive way by practicing with non-negative things. For example, just for practice, give him a little extra TV time instead of homework time one night, to show that changes in the routine can often be fun and good. Then practice with a neutral change (homework after dinner instead of before dinner), then with a negative one (changing play time into chore time). This process can help your child grow accustomed to the idea of change and learn to adapt without becoming anxious.
For continual, ongoing anxiety, many parents have begun using anti-anxiety medications for their autistic children. Usually, the medications are selective serotonin reuptake inhibitors (SSRIs), and are also used for obsessive-compulsive disorder and depression. Prozac, Luvox, Zoloft and Anafranil are all common for anxiety in autistic children.
For behavioral problems, antipsychotics such as Haldol, fluphenazine and chlorpromazine can be prescribed. These can reduce aggression in autistic kids, but sometimes also cause sedation and muscle stiffness.
All patients are different. You and your doctor should monitor your child’s progress very closely, using the lowest dose of medication possible, to see if what improvements it makes and whether there are any adverse reactions. Medication should be the last resort for autism, not the first one. There are a number of natural remedies available if you don’t want to go down the drug route. But try behavioral and dietary modifications first, to see what improvements can be made naturally.

How Families Can Cope with Schizophrenia

admin — Sat, 29 Nov 2008 20:11:02 +0000

Schizophrenia is a mental disorder
characterized by gross distortion of reality, language disturbances,
fragmentation of thought and other troubling symptoms. The cost of caring for
schizophrenic patients comes to more than $17 billion per year in this country
– but this figure can never capture the emotional cost borne by patients and
their families. While schizophrenia is often made worse by stress, it is not
caused by bad parenting, “cold” or over-involved mothers, or any other
known psychological factor. Rather, schizophrenia probably stems from a
combination of genetic factors, biochemical abnormalities in the brain and
perhaps very early damage to the developing fetus. Nevertheless, emotional
stress — including pressure from well-meaning family members — can make the
illness worse. What can families do to help their schizophrenic relatives, and
to cope with this devastating illness?
Education is certainly paramount. Many parents still blame
themselves for causing their son’s or daughter’s illness; others accuse the
afflicted family member of laziness or self-indulgence. This sort of assigning
blame is founded in error, and can make matters worse for the individual with
schizophrenia. For example, when a family member tells the sufferer, “You
don’t need those lousy medications! You need to pull yourself together and get
a job!” he or she may mean well, but may actually do more harm than good.
Individuals with schizophrenia virtually always need to take antipsychotic
medication — they cannot “pull themselves up by their bootstraps”
through an act of will.
On the other hand, babying or coddling a family member with
schizophrenia is also unhelpful. There is a realistic middle ground that can be
reached through family education and support. This can come from mental-health
professionals, mental-health advocacy groups and from patients themselves.
Medication and Job Counseling
Use of the latest “atypical” antipsychotic
medications, such as clozapine (Clozaril) and olanzapine (Zyprexa), has made a
big difference for many individuals with schizophrenia. These newer medications
are better tolerated than older agents like haloperidol (Haldol) and work on a
wider range of symptoms. Families can advocate for the use of these newer
agents, and encourage their loved ones with schizophrenia to take their
medications on a regular basis. But medication is not the whole story.
While it is foolish to “push” schizophrenic
individuals into high-pressure jobs for which they may not be ready, it is also
unwise to assume that schizophrenia amounts to a permanent disability. Many
individuals with this illness can rejoin the workforce, with appropriate
vocational rehabilitation and lots of emotional support.
In fact, a recent study by Dr. R.E. Drake and colleagues at
Dartmouth Medical School found that many patients get into the job market
faster than was once thought. Rather than getting “stalled” in the
usual sheltered workshops, the patients in this study were able to secure
competitive jobs quite rapidly, and hold these jobs. This was probably because
the patients received ongoing counseling, transportation assistance and help in
dealing with their employers.