8,274 results on '"Lorazepam"'
Search Results
2. Haloperidol and Lorazepam in Controlling Symptoms of Persistent Agitated Delirium in Patients With Advanced Cancer Undergoing Palliative Care
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National Cancer Institute (NCI)
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- 2024
3. Fasting Study of Lorazepam Tablets 2 mg and Ativan Tablets 2 mg
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Will Sullvan, Global Head of Product Risk and Safety Management
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- 2024
4. Intranasal Dexmedetomidine vs. Standard of Care for Emergency Department (ED) Procedural Sedation in the Older Adult
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Jay Brenner, Professor
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- 2024
5. Therapies for Down Syndrome Regression Disorder
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Children's Hospital Los Angeles
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- 2024
6. Effect of Ketanserin, Olanzapine, and Lorazepam After LSD Administration on the Acute Response to LSD in Healthy Subjects (LBL)
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- 2024
7. Haloperidol and Lorazepam for Delirium in Patients With Advanced Cancer
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National Cancer Institute (NCI)
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- 2024
8. Postoperative exacerbated cough hypersensitivity syndrome induces dramatic respiratory alkalosis, lactatemia, and electrolyte imbalance.
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Baettig, Sascha Jan, Fend, Raluca Ruxandra, Gero, Daniel, Gutschow, Christian, and Schlaepfer, Martin
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HERNIA surgery , *DISEASE exacerbation , *RESPIRATORY alkalosis , *LAPAROSCOPY , *MORPHINE , *CLONIDINE , *ALLERGIES , *SEVERITY of illness index , *TREATMENT effectiveness , *SURGICAL complications , *TRACHEA intubation , *RECOVERY rooms , *DICLOFENAC , *HYPERLACTATEMIA , *WATER-electrolyte imbalances , *FUNDOPLICATION , *COUGH , *LORAZEPAM , *DISEASE complications ,DIGESTIVE organ surgery - Abstract
Background: The perioperative management of patients with chronic cough or cough hypersensitivity syndrome and its sometimes severe effects is currently under-researched and under-reported. Case presentation: A 46-year-old female patient with a history of chronic cough and Cough Hypersensitivity Syndrome. After laparoscopic hiatoplasty and anterior fundoplication under general anesthesia, experienced a pronounced exacerbation of coughing symptoms. Despite prompt and extensive treatment involving antitussives, inhalants, anxiolytics, and sedatives, the symptoms remained uncontrollable. Within a few hours, the patient developed a respiratory alkalosis with severe and life-threatening electrolyte shift (pH 7.705, pCO2 1.72 kPa, K+ 2.1 mmol/l). Lactatemia lasted for more than 12 hours with values up to 6.6 mmol/l. Acute bleeding, pneumothorax, and an acute cardiac event were ruled out. Deep analgosedation and inhalation of high-percentage local anesthetics were necessary to manage the clinical symptoms. Conclusions: This case highlights the challenging nature of chronic cough and hypersensitivity syndrome perioperatively. A tailored anesthesiologic approach, exclusion of other provoking medical problems, and knowledge of possible management and treatment options are key. [ABSTRACT FROM AUTHOR]
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- 2024
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9. Determination of Lorazepam and Diazepam Using Modified Nanocrystalline Cellulose for Ultrasonic-Assisted Dispersive Solid Phase Microextraction (UA-DSPME) and Gas Chromatography-Mass Spectrometry (GC-MS).
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Haji Abdolrasouli, Mehdi, Roostaie, Ali, Abedi, Hamid, and Mohammadiazar, Sirwan
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GAS chromatography/Mass spectrometry (GC-MS) , *SOLID phase extraction , *LIQUID-liquid extraction , *DIAZEPAM , *CELLULOSE , *FOURIER transform infrared spectroscopy , *LORAZEPAM - Abstract
A rapid and effective method utilizing ultrasonic assisted-dispersive solid-phase microextraction coupled with gas chromatography/mass spectrometry (GC/MS) was developed for the determination of lorazepam and diazepam in biological and aqueous samples. A modified nanocrystalline cellulose-based sorbent was prepared and applied for the microextraction of the analytes. The extraction efficiency of the sorbents prepared using self-assembled N-(2-aminoethyl)-3-aminopropyltrimethoxysilane, including cellulose nanostructure and modified nanocrystalline cellulose, was compared. The modified cellulose nanostructure was characterized using thermogravimetric analysis (TGA), energy dispersive X-ray (EDX), and Fourier transform infrared spectroscopy (FTIR). Additionally, the study investigated the effects of relevant factors on the extraction/desorption performance, including extraction time, ionic strength, and the type and volume of the desorption solvent. The method achieved limits of detection of 1 ng mL−1 and 3 ng mL−1 and quantification limits of 4 ng mL−1 and 10 ng mL−1 for lorazepam and diazepam, respectively. Furthermore, the developed method demonstrated good repeatability with relative standard deviations of 4% and 6% (n = 5) for the spiked analyte aqueous solutions at 50 ng mL−1. The method also exhibited high linearity (R > 0.9996) in the range from 10 to 1000 ng mL−1. [ABSTRACT FROM AUTHOR]
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- 2024
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10. Chemical Stability of Lorazepam Oral Solution Repackaged in Plastic Oral Syringes at Room and Refrigerated Temperature.
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Brown, Stacy D., Sergent, Sophia, Morris, Samantha, Tubolino, Michelle, and Coffey, Timothy
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HIGH performance liquid chromatography , *REFRIGERATION & refrigerating machinery , *DRUG storage , *STATISTICAL sampling , *ORAL drug administration , *DESCRIPTIVE statistics , *DRUG packaging , *SYRINGES , *DRUG stability , *TEMPERATURE , *LORAZEPAM , *TIME - Abstract
Purpose: Generic lorazepam oral solution is supplied in a 30 mL multi-dose bottle requiring protection from light and refrigeration, with a beyond use date of 90 days once the bottle is opened. The repackaging of 1 mL doses of lorazepam oral solution into oral syringes allows for facilitated dispensing, yet no available data supports repackaging and storing lorazepam oral solution in syringes. The validation and application of a stability-indicating high-performance liquid chromatography with ultraviolet detection (HPLC-UV) method for the quantification of lorazepam allowed for the determination of the stability of lorazepam oral solution when stored in oral syringes. Methods: A stability-indicating HPLC-UV method was developed for the quantification of lorazepam in oral solution. The method was validated using guidance from USP < 1225 >. For the stability investigation, 2 mg/mL lorazepam oral solution was aliquoted into clear plastic oral syringes in 1 mLmilliliter doses from 2 multi-dose stock bottles and randomly allocated for storage in room temperature or refrigerated environment. Baseline lorazepam concentrations were measured on the day the study was initiated and designated as 100% initial concentration samples. Subsequent samples were analyzed in triplicate at time points of 24, 48, and 96 hours and 7, 10, 14, 21, 30, and 60 days. Results: The calibration curves on three non-consecutive days met the linearity criteria of R 2 > 0.99. Inter- day and intra-day precision and accuracy (percent relative standard deviation and percent error) were ≤2% over three days. During the stability investigation, percent initial concentration of lorazepam from room and refrigerated syringes remained above 90% for the duration of the study. Conclusion: The stability-indicating HPLC-UV method was successfully applied to the investigation of lorazepam oral solution stability when stored in syringes at room and refrigerated temperatures. The emergent need for use of lorazepam concentrate for inpatients and the restrictions of how the medication is supplied necessitated a need for the evaluation of repackaging into unit dose syringes for immediate availability from automated dispensing cabinets. Lorazepam oral solution stored in clear plastic syringes maintained greater than 90% initial concentration at both room and refrigerated temperatures for 60 days. [ABSTRACT FROM AUTHOR]
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- 2024
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11. The effectiveness of the lorazepam challenge test in pediatric catatonia: A multisite retrospective cohort study.
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Luccarelli, James, McCoy, Thomas H., York, Tasia, Baldwin, Isaac, Fricchione, Gregory, Fuchs, Catherine, and Smith, Joshua R.
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CHILD patients , *PEDIATRIC therapy , *NEUROBEHAVIORAL disorders , *LORAZEPAM , *CATATONIA - Abstract
Catatonia is a neuropsychiatric disorder associated with changes in behavior and affect. In adults, catatonia can respond rapidly to treatment with benzodiazepines as part of the "lorazepam challenge test." The acute effectiveness of benzodiazepine treatment in pediatric catatonia, however, has received less study. This study reports catatonia severity as measured by the Bush Francis Catatonia Rating Scale (BFCRS) in pediatric patients before and after treatment with lorazepam. Multicenter retrospective cohort study from 1/1/2018 to 6/1/2023 of patients aged 18 and younger with a clinical diagnosis of catatonia and assessment using the BFCRS before and after treatment with lorazepam. Among 54 patients, median age was 16, and 26 (48.1 %) were female. Neurodevelopmental disabilities were present in 24 (44.4 %) of patients. Prior to treatment, patients had a mean BFCRS score of 16.6 ± 6.1, which significantly reduced to 9.5 ± 5.3 following treatment with lorazepam (mean paired difference 7.1; t = 9.0, df = 53, p < 0.001), representing a large effect size (Hedges's g = 1.20; 95 % CI: 0.85 to 1.55). No significant association was found between lorazepam dose or route of administration and clinical response, nor were age, sex, study site, the presence of a neurodevelopmental disorder, the presence of hyperactive catatonic features, or the time between treatment and reassessment associated with post-treatment BFCRS. Lorazepam resulted in a rapid improvement in BFCRS score in pediatric patients, with a large effect size. Further research is needed into optimal dosing and route of administration of the lorazepam challenge test in pediatric patients. [ABSTRACT FROM AUTHOR]
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- 2024
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12. Neuropsychiatric Effects Associated with Opioid-Based Management for Palliative Care Patients.
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Kaye, Alan D., Dufrene, Kylie, Cooley, Jada, Walker, Madeline, Shah, Shivam, Hollander, Alex, Shekoohi, Sahar, and Robinson, Christopher L.
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Purpose of Review: The abundance of opioids administered in the palliative care setting that was once considered a standard of care is at present necessitating that providers evaluate patients for unintentional and deleterious symptomology related to aberrant opioid use and addiction. Polypharmacy with opioids is dynamic in affecting patients neurologically, and increased amounts of prescriptions have had inimical effects, not only for the individual, but also for their families and healthcare providers. The purpose of this review is to widen the perspective of opioid consequences and bring awareness to the numerous neuropsychiatric effects associated with the most commonly prescribed opioids for patients receiving palliative care. Recent Findings: Numerous clinical and research studies have found evidence in support for increased incidence of opioid usage and abuse as well as undesirable neurological outcomes. The most common and concerning effects of opioid usage in this setting are delirium and problematic drug-related behavioral changes such as deceitful behavior towards family and physicians, anger outbursts, overtaking of medications, and early prescription refill requests. Other neuropsychiatric effects detailed by recent studies include drug-seeking behavior, tolerance, dependence, addictive disorder, anxiety, substance use disorder, emotional distress, continuation of opioids to avoid opioid withdrawal syndrome, depression, and suicidal ideation. Summary: Opioid usage has detrimental and confounding effects that have been overlooked for many years by palliative care providers and patients receiving palliative care. It is necessary, even lifesaving, to be cognizant of potential neuropsychiatric effects that opioids can have on an individual, especially for those under palliative care. By having an increased understanding and awareness of potential opioid neuropsychiatric effects, patient quality of life can be improved, healthcare system costs can be decreased, and patient outcomes can be met and exceeded. [ABSTRACT FROM AUTHOR]
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- 2024
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13. Benzodiazepines
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Masson, Sylvia, Bleuer-Elsner, Stéphane, Muller, Gérard, Médam, Tiphaine, Chevallier, Jasmine, Gaultier, Emmanuel, Masson, Sylvia, Bleuer-Elsner, Stéphane, Muller, Gérard, Medam, Tiphaine, Chevallier, Jasmine, and Gaultier, Emmanuel
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- 2024
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14. LORA-PITA IV General Investigation
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- 2023
15. Multi-modal Assessment of Gamma-aminobutyric Acid (GABA) Function in Psychosis (GABAmech)
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National Institute of Mental Health (NIMH) and Stephan F. Taylor, Professor of Psychiatry
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- 2023
16. Meth-OD: A Study of IXT-m200 in Patients With Toxicity From Methamphetamine Overdose (Meth-OD)
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National Institute on Drug Abuse (NIDA)
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- 2023
17. Processes and Circuitry Underlying Threat Sensitivity as a Treatment Target for Co-morbid Anxiety and Depression
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National Institute of Mental Health (NIMH) and California Institute of Technology
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- 2023
18. Evaluating Sublingual Dexmedetomidine For Moderate To Severe Agitation In Inpatients With Schizophrenia Or Bipolar Disorder
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BioXcel Therapeutics Inc and Justin Faden, Associate Professor of Psychiatry
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- 2023
19. Pharmacologic management of adolescent catatonia: A dual-case series
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Lauren Leiby, PharmD, BCPP, Lauryn Shiplett, PharmD, BCPP, Wendy Lin, PharmD, Matthew Dick, PharmD, BCPP, and Hannah Thornton, PharmD, MS
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catatonia ,pediatrics ,child and adolescent psychiatry ,lorazepam ,benzodiazepine ,ect ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 ,Pharmacy and materia medica ,RS1-441 - Abstract
Introduction Catatonia is a syndrome characterized by psychomotor and behavioral disturbances and is associated with a substantially increased mortality risk in adolescent patients. There is a dearth of published literature describing treatment strategies for pediatric patients with catatonia. This dual-case series will describe the treatment course of 2 adolescent patients with catatonia at our pediatric inpatient psychiatric facility. Case Series This case series presents 2 adolescent patients (a 17-year-old male and a 16-year-old female) who initially presented with worsening agitation and paranoia, later developing catatonia. Both patients required long durations of hospitalization and were treated with high-dose lorazepam before requiring the addition of electroconvulsive therapy (ECT). Discussion Treatment of pediatric patients with catatonia creates a significant burden on patients, families, and the healthcare system. Treatment with high-dose benzodiazepines is high risk, while ECT is both difficult to access and comes with its own risks. Both patients discussed are transitional age, meaning they will soon be young adults who will continue to require high-level psychiatric care. Psychiatric pharmacists have a large role to play in ensuring safe medication management for these complex patients. Conclusions This case series of 2 adolescent patients with catatonia demonstrates marginal reduction in symptoms with high-dose lorazepam in conjunction with ECT, with minimal side effects. This case series adds to the limited available literature regarding treatment of catatonia in pediatric patients and highlights the need for further study into effective treatment alternatives.
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- 2024
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20. Influence of GABAA and GABAB receptor activation on auditory sensory gating and its association with anxiety in healthy volunteers.
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de la Salle, Sara, Piche, Justin, Duncan, Brittany, Choueiry, Joëlle, Hyde, Molly, Aidelbaum, Robert, Baddeley, Ashley, Impey, Danielle, Rahmani, Noreen, Ilivitsky, Vadim, and Knott, Verner
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GABA receptors , *ANXIETY , *EVOKED potentials (Electrophysiology) , *VOLUNTEERS , *FAILURE (Psychology) , *ANXIETY disorders - Abstract
Background: Dysfunctional sensory gating in anxiety disorders, indexed by the failure to inhibit the P50 event-related potential (ERP) to repeated stimuli, has been linked to deficits in the major inhibitory neurotransmitter γ-aminobutyric acid (GABA). Aims/Methods: This study, conducted in 30 healthy volunteers, examined the acute effects of GABAA (lorazepam: 1 mg) and GABAB receptor (baclofen: 10 mg) agonists on P50 measures of auditory sensory gating within a paired-stimulus (S1-S2) paradigm and assessed changes in gating in relation to self-ratings of anxiety. Results: Compared to placebo, lorazepam reduced ERP indices of sensory gating by attenuating response to S1. Although not directly impacting P50 inhibition, baclofen-induced changes in gating (relative to placebo) were negatively correlated with trait but not state anxiety. Conclusions: These preliminary findings support the involvement of GABA in sensory gating and tentatively suggest a role for GABAB receptor signaling in anxiety-associated gating dysregulation. [ABSTRACT FROM AUTHOR]
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- 2024
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21. Strategic Utilization of Dantrolene in a Case of Severe Acute Generalized Tetanus.
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Kataria, Vivek, Agha, Terra, Ryman, Klayton, and Iyer, Nithya
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BENZODIAZEPINES , *ATRACURIUM , *ACUTE diseases , *LEG , *TETANUS , *NECROSIS , *TETANUS vaccines , *SEVERITY of illness index , *MIDAZOLAM , *TRANQUILIZING drugs , *DISCHARGE planning , *PROPOFOL , *INTRAVENOUS therapy , *PARASYMPATHOLYTIC agents , *DOSAGE forms of drugs , *DANTROLENE , *WOUND care , *GENETIC techniques , *NEUROMUSCULAR blockade , *TRISMUS , *LORAZEPAM , *OPERATING rooms , *ADULTS - Abstract
Tetanus is a life-threatening, vaccine-preventable disease caused by an endotoxin produced by Clostridium tetani. We report a case of severe tetanus in an adult male with a history of intravenous drug use. The patient presented with a 1-day history of inability to open his jaw and a right lower extremity necrotic wound. Initial management consisted of tetanus toxoid, human tetanus immunoglobulin, antimicrobials and intermittent lorazepam. Due to progressive symptoms, wound debridement and placement of an advanced airway in the operating room ensued. Episodes of tetany were associated with fever, autonomic instability, acute desaturations and preemptive ventilator triggering despite maximum doses of continuous propofol and midazolam. Neuromuscular blockade with cisatracurium was added, resulting in control of tetany. Despite initial control, NMB could not be weaned due to recurrent spasms. Intravenous dantrolene was therefore sought as an alternative antispasmodic. Following an initial load, patient was successfully liberated from cisatracurium. Dantrolene was therefore converted to enteral to facilitate gradual down-titration of intravenous sedatives with subsequent conversion to oral benzodiazepines. After a prolonged hospital course, the patient was able to be discharged home. Dantrolene was thus effectively utilized as an adjunctive antispasmodic agent to facilitate liberation from cisatracurium and continuous sedation. [ABSTRACT FROM AUTHOR]
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- 2024
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22. Anesthetic options for Rezum water vapor therapy.
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Bal, Dhiraj S., Urichuk, Matthew, Panchendrabose, Kapilan, Ramjiawan, Ryan, Shah, Jainik, Gebru, Naomi, Pandian, Alagarsamy, and Patel, Premal
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STEAM therapy , *CONSCIOUS sedation , *HEALTH services accessibility , *T-test (Statistics) , *INTERVIEWING , *MINIMALLY invasive procedures , *TREATMENT duration , *TREATMENT effectiveness , *DESCRIPTIVE statistics , *OXYCODONE , *MANN Whitney U Test , *LONGITUDINAL method , *HEALTH outcome assessment , *COMPARATIVE studies , *ANESTHESIA , *MEDICAL care costs , *ACETAMINOPHEN , *LORAZEPAM , *EVALUATION ,PREVENTION of surgical complications - Abstract
INTRODUCTION: There has been a rapid expansion of the armamentarium for managing benign prostatic hyperplasia (BPH). Due to the invasiveness and complication risks of traditional surgical management, minimally invasive procedures have emerged. Rezūm water vapor therapy is a safe, effective alternative. Given the minimally invasive nature, there is interest in administering conscious sedation over general anesthesia to decrease procedural times and costs and increase accessibility by completing procedures in an office-based setting. We sought to assess and describe patient-reported tolerability for Rezūm completed under oral and deep intravenous sedation. METHODS: Patients who underwent Rezūm between April and November of 2022 under conscious sedation with oral sedation and local anesthesia (OSLA) or deep intravenous sedation (DIS) were enrolled. Baseline information was collected, and followup interviews were conducted where patient tolerability scores, future anesthetic preferences, and complication data was prospectively obtained. RESULTS: Fourteen patients were enrolled in each group. The OSLA and DIS cohorts had a median tolerability score of 8 (interquartile range [IQR] 3.5) and 9 (IQR 1.75), respectively, indicating highly tolerable experiences. There was no significant difference between groups (p=0.13). On followup, 85.7% of patients in the OSLA and 100% in DIS groups expressed their future preference for conscious sedation over general anesthetic, with no significant difference between the two groups (p=0.46). CONCLUSIONS: Our study demonstrates OSLA and DIS are both viable conscious sedation methods for Rezūm, with patients reporting high tolerability to the procedure regardless of sedation choice. Almost all patients receiving conscious sedation would choose to undergo Rezūm using conscious sedation again and had minimal complications. [ABSTRACT FROM AUTHOR]
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- 2024
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23. LORAZEPAM FOR THE MANAGEMENT OF POSTERIOR FOSSA MUTISM: A CASE REPORT.
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Alfakeh, Sulhi, Alesa, Alaa, Sabbagh, Abdulrahman J., and Basurrah, Abdulaziz A.
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POSTERIOR fossa syndrome , *CEREBELLAR tumors , *SURGICAL excision , *PERSONALITY change , *INFRATENTORIAL brain tumors ,TUMOR surgery - Abstract
Posterior Fossa Syndrome (PFS) is a condition that can develop in children and adults following a cerebellar tumor resection surgery. The syndrome is characterized by multiple symptoms, including mutism, personality changes, and mobility problems. We present a case of a four-year-old boy diagnosed with posterior fossa tumor with secondary hydrocephalus who underwent an uneventful total resection of the tumor and developed posterior fossa syndrome, including mutism, was managed using lorazepam and made a full recovery of almost all of the symptoms he developed. Posterior fossa syndrome has multiple symptoms, most of which are usually transient. The exact pathophysiology and time to recovery are still not fully known. Patients with posterior fossa syndrome are managed with a multidisciplinary approach. Mutism resulting from this syndrome is proven to be successfully managed by lorazepam. [ABSTRACT FROM AUTHOR]
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- 2024
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24. Travel/carrier phobia and situational fear in a 1-year-old female spayed domestic shorthair cat: A case report.
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Kirby-Madden, Taylor and Herron, Meghan
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• Case report for travel/carrier phobia and situational fear in young spayed female cat. • Counter-conditioning and behavior modification treatment protocol successful in building voluntary approaches to large crate for travel. • Psychopharmacological support with gabapentin and lorazepam required for in-home veterinary care, but well-tolerated. • Combination of commercial and compounded preparations necessary. • Acepromazine discontinued due to lack of efficacy. A 1-year-old spayed female DSH cat was evaluated for profound fear of the travel carrier, veterinary handling, and new people in her home. The patient was diagnosed with specific phobia (carrier/veterinary handling) with situational fear (of new people) after a behavioral and medical assessment. Treatment with environmental changes, specific training/behavior modification for entering a novel crate, and the event medications gabapentin and lorazepam significantly improved the patient's fear and phobia. These combined interventions allowed for veterinary care to be administered and for routine car travel. [ABSTRACT FROM AUTHOR]
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- 2024
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25. A Comparison of Injectable Diazepam and Lorazepam in the Goal-Directed Management of Severe Alcohol Withdrawal.
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Brickel, Kendall H., Hodge, Emily K., Zavgorodnyaya, Daria, Schroeder, John M., Brown, Lawrence H., and Daley, Mitchell J.
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DIAZEPAM ,TERMINATION of treatment ,LORAZEPAM ,ALCOHOL withdrawal syndrome ,INTENSIVE care patients - Abstract
Background: Benzodiazepines are the gold standard for treatment of alcohol withdrawal, yet the selection of a preferred benzodiazepine is limited due to a lack of comparative studies. Objectives: The primary objective of this study was to compare the efficacy and safety of injectable lorazepam (LZP) and diazepam (DZP) in the treatment of severe alcohol withdrawal syndrome (AWS). Methods: Retrospective cohort study of adult patients admitted to an intensive care unit with a primary diagnosis of AWS. Subjects who received at least 12 LZP equivalent units (LEU) of injectable DZP or LZP within 24 hours of initiation of the severe AWS protocol were included. The primary outcome was time with Clinical Institute Withdrawal Assessment for Alcohol–Revised (CIWA-Ar) scores at goal over the first 24 hours of treatment. Results: A total of 191 patients were included (DZP n = 89, LZP n = 102). Time with CIWA-Ar scores at goal during the first 24 hours was similar between groups (DZP 12 hours [interquartile range, IQR, = 9-15] vs LZP 14 hours [IQR = 10-17]), P = 0.06). At 24 hours, LEU requirement was similar (DZP 40 [IQR = 22-78] vs LZP 32 [IQR = 18-56], P = 0.05). Drug cost at 24 hours was higher in the DZP group ($204.6 [IQR = 112.53-398.97] vs $8 [IQR = 4.5-14], P < 0.01). Conclusion and Relevance: DZP or LZP are equally efficacious for the treatment of severe AWS. LZP may be preferred due to cost but both medications can be used interchangeably based on availability. [ABSTRACT FROM AUTHOR]
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- 2024
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26. Acute psychosis following baclofen overdose.
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Mostafa, Khandaker, Kelbrick, Marlene, Mustafa, Feras, Willis, Gemma, and Paduret, Gabriela
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DRUG therapy for psychoses , *BACLOFEN , *DRUG overdose , *SEDATIVES , *OLANZAPINE , *DOXYCYCLINE , *ANXIETY , *INTUBATION , *MUSCLE hypotonia , *HALLUCINATIONS , *PSYCHOSES , *ALCOHOL drinking , *LORAZEPAM , *PSYCHIATRIC drugs , *HAEMOPHILUS diseases , *C-reactive protein - Abstract
Baclofen is widely used as a muscle relaxant in neurological and other physical health conditions, as well as for its anticraving effects in substance use disorder. Here the authors describe a case of baclofen overdose resulting in acute psychosis. Clinicians need to consider this in the differential diagnosis of first episode psychosis presentations, as unrecognised, and untreated baclofen overdose‐induced psychosis can be associated with significant morbidity and potential mortality. [ABSTRACT FROM AUTHOR]
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- 2024
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27. Catatonia and melancholia interface: exploring a new paradigm for evaluation and treatment. A case series and literature review.
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Mahgoub, Yassir, Pathare, Aum, Hamlin, Dallas, Gomaa, Hassaan, Nutting, Sean, Mormando, Charles, and Francis, Andrew
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LITERATURE reviews ,MENTAL depression ,CATATONIA ,BIPOLAR disorder ,GABA agonists - Abstract
Background: Catatonia has been increasingly associated with mood disorders and is recognized as a specifier in the DSM-5 and DSM-5-TR. The DSM-5-TR recognizes melancholia as a specifier for depressive episodes in major depressive disorder and bipolar disorder. It is characterized by severe anhedonia, lack of reactivity, excessive or delusional guilt, and significant vegetative symptoms. As the conceptualization of melancholia expanded beyond its mood components to include psychomotor disturbances, its overlap with psychomotor symptoms or catatonia becomes evident. This overlap was also described in Kahlbaum's original literature, where he describes the transition between states of melancholia, mania, and catatonia. Method: Case summary of six patients with major depressive disorder or depressed phase of bipolar disorder who were admitted for severe depression, anhedonia, intense anxiety, psychomotor agitation or retardation, indecisiveness, perseveration, and vegetative symptoms such as poor sleep, appetite, and significant weight loss. Results: All patients demonstrated rapid and complete resolution of their mood and psychomotor symptoms, indecisiveness, perseveration, as well as psychosis shortly after administration of lorazepam, with recurrence of the above symptoms upon lorazepam discontinuation and resolution upon resumption, in an on-and-off manner. Conclusion: The present study argues for a closer relationship between melancholia and catatonia based on our case series, historical review, overlap in phenomenology, and response to treatment. We propose provisional [Mahgoub] criteria for patients with severe depression and melancholia. The role of GABA agonists, such as lorazepam, can be explored as an option for patients with treatment-resistant depression who meet these criteria for melancholia. Limitations: Absence of a standardized, systematic assessment tool and a small sample size. [ABSTRACT FROM AUTHOR]
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- 2024
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28. Placebo Effects Are Small on Average in the 7.5% CO2 Inhalational Model of Generalized Anxiety.
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Huneke, Nathan T M, Cross, Cosmina, Fagan, Harry A, Molteni, Laura, Phillips, Naomi, Garner, Matthew, and Baldwin, David S
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ANXIETY ,NOCEBOS ,ANXIETY disorders ,PLACEBOS ,PREFRONTAL cortex ,DRUG therapy ,LORAZEPAM - Abstract
Background Anxiety disorders are highly prevalent and socio-economically costly. Novel pharmacological treatments for these disorders are needed because many patients do not respond to current agents or experience unwanted side effects. However, a barrier to treatment development is the variable and large placebo response rate seen in trials of novel anxiolytics. Despite this, the mechanisms that drive placebo responses in anxiety disorders have been little investigated, possibly due to low availability of convenient experimental paradigms. We aimed to develop and test a novel protocol for inducing placebo anxiolysis in the 7.5% CO
2 inhalational model of generalized anxiety in healthy volunteers. Methods Following a baseline 20-minute CO2 challenge, 32 healthy volunteers were administered a placebo intranasal spray labelled as either the anxiolytic "lorazepam" or "saline." Following this, participants surreptitiously underwent a 20-minute inhalation of normal air. Post-conditioning, a second dose of the placebo was administered, after which participants completed another CO2 challenge. Results Participants administered sham "lorazepam" reported significant positive expectations of reduced anxiety (P = .001), but there was no group-level placebo effect on anxiety following CO2 challenge post-conditioning (P s > .350). Surprisingly, we found many participants exhibited unexpected worsening of anxiety, despite positive expectations. Conclusions Contrary to our hypothesis, our novel paradigm did not induce a placebo response, on average. It is possible that effects of 7.5% CO2 inhalation on prefrontal cortex function or behavior in line with a Bayesian predictive coding framework attenuated the effect of expectations on subsequent placebo response. Future studies are needed to explore these possibilities. [ABSTRACT FROM AUTHOR]- Published
- 2024
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29. Resistance Under the Microscope
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Markus Klimek, Vice-head of Anesthesiology
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- 2023
30. Disulfiram Combined With Lorazepam for Alcohol Dependence and Anxiety Disorder
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National Institute on Alcohol Abuse and Alcoholism (NIAAA) and Michael Bogenschutz, Professor of Psychiatry
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- 2023
31. Liver Fibrosis in Alpha-1 Antitrypsin Deficiency (Liver AATD)
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- 2023
32. Psilocybin for Treatment of Obsessive Compulsive Disorder (PSILOCD)
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Francisco A Moreno, Associate Vice President, Diversity and Inclusion; Professor, Psychiatry
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- 2023
33. Effects of lorazepam on saccadic eye movements – evidence from prosaccade and free viewing tasks
- Author
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Baumert, Philine M., Faßbender, Kaja, Wintergerst, Maximilian W. M., Terheyden, Jan H., Aslan, Behrem, Foulsham, Tom, Harmening, Wolf, and Ettinger, Ulrich
- Published
- 2024
- Full Text
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34. Long‐term benzodiazepine usage and mortality in patients with chronic non‐cancer musculoskeletal pain: A Nationwide cohort study.
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Oh, Tak Kyu, Hwang, Insung, and Song, In‐Ae
- Subjects
- *
BENZODIAZEPINES , *RISK assessment , *NONSTEROIDAL anti-inflammatory agents , *STATISTICAL models , *SUBSTANCE abuse , *POST-traumatic stress disorder , *WOUNDS & injuries , *MUSCULOSKELETAL pain , *CHRONIC pain , *DIAZEPAM , *TRIAZOLAM , *T-test (Statistics) , *DISEASE duration , *STATISTICAL sampling , *CHLORDIAZEPOXIDE , *MULTIPLE regression analysis , *INSOMNIA , *MUSCULOSKELETAL system diseases , *QUESTIONNAIRES , *TRANQUILIZING drugs , *CAUSES of death , *DESCRIPTIVE statistics , *ALPRAZOLAM , *CHI-squared test , *AGE distribution , *SEVERITY of illness index , *RESPIRATORY diseases , *LONGITUDINAL method , *ODDS ratio , *NEUROLOGICAL disorders , *CHRONIC diseases , *ANALGESICS , *OPIOID analgesics , *GABAPENTIN , *DATA analysis software , *CLONAZEPAM , *SURVIVAL analysis (Biometry) , *CONFIDENCE intervals , *ANXIETY disorders , *COMORBIDITY , *PREGABALIN , *ACETAMINOPHEN , *PROPORTIONAL hazards models , *CLOBAZAM , *LORAZEPAM , *POISONING ,CARDIOVASCULAR disease related mortality - Abstract
Objectives: The impact of benzodiazepine use on mortality in patients with chronic non‐cancer pain (CNCP) has not been identified. We aimed to examine the factors associated with benzodiazepine use among patients with CNCP and examine whether long‐term benzodiazepine usage is associated with mortality in patients with CNCP. Methods: This study was conducted using data from the National Health Insurance Service database of South Korea. We selected 2.5% of all adult patients diagnosed with musculoskeletal diseases (MSD) in South Korea from 2010 to 2019 using a stratified random sampling technique and included them in the analysis as patients with CNCP. The risk of 10‐year all‐cause mortality in patients with CNCP was investigated using the 2010 cohort of patients with CNCP. Results: The proportion of the study population that used benzodiazepine during the 10‐year study period was 2.1% (390,683/18,770,234). Multivariable logistic regression showed that old age; increased Charlson comorbidity index (CCI); opioid, gabapentin or pregabalin, paracetamol, non‐steroidal anti‐inflammatory drugs, and Z‐drugs usage; and underlying psychiatric comorbidities were associated with increased benzodiazepine use. In addition, benzodiazepine use was associated with increased 10‐year all‐cause mortality (adjusted hazard ratio: 1.03, 95% confidence interval: 1.01, 1.06; p < 0.001). Conclusions: Benzodiazepine was prescribed to 2.1% of the patients with CNCP in South Korea from 2010 to 2019. Old age, increased CCI, underlying psychiatric comorbidities, and use of certain drugs are associated with increased use of benzodiazepines. In addition, benzodiazepine use is associated with 10‐year all‐cause mortality in patients with CNCP. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
35. Effectiveness of an Algorithmic Approach to Ventilator Withdrawal at the End of Life: A Stepped Wedge Cluster Randomized Trial.
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Campbell, Margaret L. and Yarandi, Hossein N.
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- *
TERMINAL care , *LORAZEPAM , *SAMPLE size (Statistics) , *EFFECT sizes (Statistics) , *PATIENT-centered care , *ADULT respiratory distress syndrome , *RISK assessment , *RANDOMIZED controlled trials , *MORPHINE , *DYSPNEA , *ARTIFICIAL respiration , *DESCRIPTIVE statistics , *RESEARCH funding , *VENTILATOR weaning , *OPIOID analgesics , *ALGORITHMS , *PALLIATIVE treatment , *DISEASE risk factors - Abstract
Background: The transition to spontaneous breathing puts patients who are undergoing ventilator withdrawal at high risk for developing respiratory distress. A patient-centered algorithmic approach could standardize this process and meet unique patient needs because a single approach (weaning vs. one-step extubation) does not capture the needs of a heterogenous population undergoing this palliative procedure. Objectives: (1) Demonstrate that the algorithmic approach can be effective to ensure greater patient respiratory comfort compared to usual care; (2) determine differences in opioid or benzodiazepine use; (3) predict factors associated with duration of survival. Design/Settings/Measures: A stepped-wedge cluster randomized design at five sites was used. Sites crossed over to the algorithm in random order after usual care data were obtained. Patient comfort was measured with the Respiratory Distress Observation Scale© (RDOS) at baseline, at ventilator off, and every 15-minutes for an hour. Parenteral morphine and lorazepam equivalents from the onset of the process until patient death were calculated. Results: Usual care data n = 120, algorithm data n = 48. Gender and race were evenly distributed. All patients in the usual care arm underwent a one-step ventilator cessation; 58% of patients in the algorithm arm were weaned over an average of 18 ± 27 minutes as prescribed in the algorithm. Patients had significantly less respiratory distress in the intervention arm (F = 10.41, p = 0.0013, effective size [es] = 0.49). More opioids (t = −2.30, p = 0.023) and benzodiazepines (t = −2.08, p = 0.040) were given in the control arm. Conclusions: The algorithm was effective in ensuring patient respiratory comfort. Surprisingly, more medication was given in the usual care arm; however, less may be needed when distress is objectively measured (RDOS), and treatment is initiated as soon as distress develops as in the algorithm. Clinical Trial Registration number: NCT 03121391. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
36. Inconsolability in a Nonverbal Adolescent.
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Bhowal, Anushka, Cooper, Felicia, and Donner, Elizabeth
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- *
PHYSICAL diagnosis , *X-rays , *NONVERBAL communication , *TACHYPNEA , *CHEST X rays , *LORAZEPAM , *CRYING , *TORSO , *AGITATION (Psychology) , *DEVELOPMENTAL disabilities , *DIFFERENTIAL diagnosis , *HAND , *TACHYCARDIA , *ANGER , *BLOOD cell count , *CLOBAZAM , *RETT syndrome , *BREATH holding , *ABDOMINAL radiography , *KETOROLAC , *SYMPTOMS , *ADOLESCENCE - Abstract
The article describes the case of a 13-year-old female with chronic medical history of presumed Rett syndrome (RTT) based on developmental regression and behavioral observation, microcephaly, seizure disorder, and gastrostomy tube dependence. Topics discussed include findings on medical examination of the patient, clinical characteristics of Rett syndrome, and differential diagnosis, workup, and outcomes of therapeutic interventions trialed for patient's agitation.
- Published
- 2024
- Full Text
- View/download PDF
37. Lorazepam in catatonia – Past, present and future of a clinical success story.
- Author
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Hirjak, Dusan, Fricchione, Gregory, Wolf, Robert Christian, and Northoff, Georg
- Subjects
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LORAZEPAM , *CATATONIA , *MEDICAL practice , *CLINICAL trials , *ZOLPIDEM - Abstract
The effect of lorazepam in the treatment of catatonia is outstanding and almost immediate. Clinicians are familiar with its effects: mute patients can speak again, akinetic patients can move again and patients with negativism can eat and drink again within usually a short duration of about 10 min to 1–2 h. Fear is often gone after lorazepam administration. While not always effective, the introduction of lorazepam into clinical practice represented a breakthrough and was often life-saving for many patients suffering from catatonia. It is rare to observe such rapid therapeutic effects in other domains of psychiatry. In this narrative review we will briefly look at the past, present and future of lorazepam in the treatment of catatonia. It is gratifying to reflect on the fact that clinicians using the age-old medical practice of observation and empirical treatment succeeded in advancing the management of catatonia 40 years ago. The present evidence shows that the clinical effect of lorazepam in catatonia treatment is excellent and more or less immediate although it remains to be explicitly tested against other substances such as diazepam, zolpidem, clozapine, quetiapine, amantadine, memantine, valproate and dantrolene in randomized clinical trials. In addition, future studies need to answer the question how long lorazepam should be given to patients with catatonia, months or even years? This narrative review promotes the rapid use of lorazepam in the treatment of acute catatonic patients and stipulates further scientific examination of its often impressive clinical effects. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
38. Nursing Approach to an Individual Diagnosed with Bipolar Disorder Based on Watson's Theory of Human Caring: A Case Report.
- Author
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Cirakoglu, Seda, Bilkay, Halil Ibrahim, and Polat, Muradiye
- Subjects
DIAGNOSIS of bipolar disorder ,BIPOLAR disorder ,KIDNEY failure ,KIDNEY transplantation ,CONTROLLED release preparations ,NURSING models ,HOSPITAL care ,OLANZAPINE ,RISPERIDONE ,ANTIPSYCHOTIC agents ,NURSING ,TREATMENT effectiveness ,INJECTIONS ,VALPROIC acid ,MILITARY service ,TACROLIMUS ,PSYCHIATRIC hospitals ,PSYCHIATRIC drugs ,LORAZEPAM - Abstract
Background: Watson's Theory Human Care (THC) is effective in the nursing care process, but its use is limited in individuals with bipolar disorder. Aim: It was aimed to use THC in the nursing approach of an individual diagnosed with bipolar disorder who was admitted to a psychiatry clinic. Method: The data of the case were collected between 01.07.2023 and 02.08.2023 in the closed psychiatry clinic of a mental health hospital serving in the Black Sea region of Turkiye. Interviews with the case were made according to THC and the nursing process was reported according to THC. In order to share the data about the individual, permission was obtained by making a statement to him and his name was not mentioned in the study. Results: The patient, who came to the clinic with complaints of grandiose delusions, suspicions and sudden anger, and was admitted to the clinic with the diagnosis of bipolar affective disorder, also has a history of kidney transplantation. An approach focused on trust and compassion was adopted with the case, and the interpersonal relations and care process were managed with the remedial methods in THC. In the care process, nursing interventions were implemented by adopting a holistic approach with a compassionate, sincere and safe interaction based on the 10 healing factors in the THC, and the results were evaluated. Conclusion: In the current case, the use of THC brings with it various limitations, while providing interaction-oriented and systematic nursing care with a holistic approach. It is recommended to increase the research conducted by nursing students and psychiatric nurses with other disciplines based on THC in individuals with bipolar disorder who are treated in closed psychiatry clinics. [ABSTRACT FROM AUTHOR]
- Published
- 2024
39. Pain and Wound Management in Fungating Merkel Cell Carcinoma within a Palliative Setting: The First Case Report of this Predicament.
- Author
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Mohan, Shaan and Khan, Ahmad
- Subjects
MERKEL cell carcinoma ,PALLIATIVE treatment ,FUNGATING wounds ,BANDAGES & bandaging ,NONAGENARIANS ,ANXIETY ,NOCICEPTIVE pain ,CANCER pain ,TENSION headache ,SCALP ,PAIN management ,WOUND care ,SURGICAL dressings ,LORAZEPAM ,DISEASE complications - Abstract
Merkel cell carcinoma (MCC) is a rare type of skin cancer of the neuroendocrine Merkel mechanoreceptors. These cells are closely associated with nerve terminals and, given their proximity to cutaneous tissue, have the propensity to develop into deeply ulcerated, fungating malignancies. These friable wounds are easily irritated, and can cause significant pain for patients. We report a palliative case of severe, fungating MCC of the left scalp where the main contributor to the patient's illness burden is pain. Having been referred to palliative care by the Tissue Viability team, this 90-year-old gentleman was complaining of episodic burning pain during dressing changes, which was associated with radiation to the forehead, nausea, and significant trait anxiety. It was theorised that this pain could be in part due to tension headache, not just nociception, and anticipatory lorazepam was prescribed to relieve trait anxiety. All symptoms were majorly relieved following this administration. A specialist dressing was implemented to absorb exudate and balance moisture, which we believe may have stopped further deterioration of pain. Overall, this report emphasises the need to consider alternative pain aetiologies other than nociception in a presentation that is not found in the literature. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
40. Sedation-analgesia, Muscle Relaxant Applications in Pediatric Intensive Care Units and Guidelines for the Management and Environment Optimization of Clinical Statements Such as Withdrawal, Delirium Developed During These Applications.
- Author
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Bozan, Gürkan, Koçkuzu, Esra, Korulmaz, Ali, Altuğ, Ümüt, and Yıldızdaş, Dinçer
- Subjects
ANXIETY prevention ,MEDICAL protocols ,MORPHINE ,KETAMINE ,BARBITURATES ,MIDAZOLAM ,ANALGESIA ,PEDIATRICS ,EMOTIONAL trauma ,ETOMIDATE ,PROPOFOL ,PHENYLPROPANOLAMINE ,DELIRIUM ,INTENSIVE care units ,PAIN ,NARCOTICS ,PHYSIOLOGICAL stress ,AMNESIA ,NEUROMUSCULAR blocking agents ,ANESTHESIA ,INTERMITTENT positive pressure breathing ,FENTANYL ,LORAZEPAM - Published
- 2024
- Full Text
- View/download PDF
41. Boy presents with fatigue, minimal responsivity, and diffuse muscle weakness.
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CHANG, BRIAN and SHARMA, YAMINI
- Subjects
BENZODIAZEPINES ,PHYSICAL therapy ,DIFFERENTIAL diagnosis ,FATIGUE (Physiology) ,TRANQUILIZING drugs ,SENSORY disorders ,MUSCLE weakness ,EATING disorders ,CATATONIA ,LORAZEPAM ,MUTISM ,DIET therapy - Abstract
The article discusses a case study of an 11-year-old male patient that was diagnosed with the neuropsychiatric syndrome catatonia. Topics explored include the medical history of the patient and the symptoms presented in the emergency department such as fatigue and diffuse muscle weakness, results of the physical and laboratory examinations performed, and the clinical improvement exhibited by the patient following the benzodiazepine challenge and treatments.
- Published
- 2024
42. Lorazepam Sedation for Critically Ill Children
- Author
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Case Western Reserve University
- Published
- 2023
43. Efficacy of Hydroxyzine for Patients With Panic Disorder
- Author
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Mohammed Al Alawi, Principal Investigator, Dr Mohmmed Al Alawi Bsc, MD,PhD, MRCPsych, OMSBPsych, ARABPsych
- Published
- 2023
44. Lorazepam
- Author
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Pant, AB
- Published
- 2024
- Full Text
- View/download PDF
45. Ziprasidone population pharmacokinetics and co-medication effects in Chinese patients
- Author
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Bao, Shuang, Yang, Siyu, Hua, Zixin, Li, Jiqian, Zang, Yannan, and Li, Xingang
- Published
- 2024
- Full Text
- View/download PDF
46. A Study of Mianserin in Combination With SSRIs in Depression With Sleep Problems
- Author
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Zhenghui YI, Director of Clinical Section VIII
- Published
- 2022
47. Evaluation of the sedative effect of sublingual lorazepam versus placebo in patients underwent endoscopy: a double-blind, randomized controlled clinical trial.
- Author
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Hasanzarrini, Maryam, Nirumandi Jahromi, Samira, Mohammad Salehi, Amir, Ataei, Sara, Seyfi, Zohreh, and Poorolajal, Jalal
- Subjects
- *
BLOOD pressure , *NONPARAMETRIC statistics , *LORAZEPAM , *ANESTHESIOLOGY , *CONFIDENCE intervals , *CONSCIOUS sedation , *INTRAOPERATIVE care , *PATIENT satisfaction , *OXYGEN saturation , *FISHER exact test , *MANN Whitney U Test , *PLACEBOS , *TREATMENT effectiveness , *RANDOMIZED controlled trials , *COMPARATIVE studies , *T-test (Statistics) , *BLIND experiment , *HEART beat , *DESCRIPTIVE statistics , *CHI-squared test , *INTRACLASS correlation , *ENDOSCOPIC gastrointestinal surgery , *ANXIETY , *STATISTICAL sampling , *MEDICAL prescriptions , *DATA analysis software , *TRANQUILIZING drugs , *PREANESTHETIC medication , *PHARMACODYNAMICS - Abstract
Background: Digestive endoscopy (DE) is uncomfortable for most patients. Lorazepam is a potent benzodiazepine with anxiolytic and sedative effects. Objective: This study aims to determine the sedative effect of sublingual lorazepam versus placebo as a premedication in patients who underwent DE. Design: This is a mono-center, double-blind, and randomized controlled trial. Methods: A lorazepam sublingual tablet was made by researchers and physical tests were done on it, then the double-blind placebo-controlled trial was done to investigate the efficacy of 2 mg sublingually administered lorazepam as a premedication for endoscopy. Lorazepam or a placebo tablet was administered sublingually 30 min before the endoscopy. The patients, nurses, and physicians were blinded to the patient group. The depth of sedation was evaluated according to the American Society of Anesthesiology. Results: In all, 116 patients were randomly assigned to take either lorazepam (n = 58) or a placebo (n = 58). The results of physical properties tests were acceptable according to United States Pharmacopeia. There were no statistical differences between groups regarding age and gender. In the lorazepam group, 75.8% of patients showed mild sedation, and 24.2% of patients showed no sedation. All of the patients in the placebo had no sedation (p = 0.001). Time of procedure (p < 0.001), intraoperative O2 saturation (p < 0.001), intraoperative heart rate (p < 0.001), and intraoperative blood pressure (p < 0.001) were significantly lower in the lorazepam group. No significant or dangerous side effects were observed except a bit of giddiness and dizziness. Conclusion: The results of this study showed that prescription of sublingual lorazepam 25–30 min before endoscopy provided mild sedation. Registration: IRCT201611039014N130 (05/11/2016); https://en.irct.ir/trial/9568. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
48. Case Report: Possible Serotonin Syndrome in a Patient Taking Kratom and Multiple Serotonergic Agents.
- Author
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Eudaley, Sarah T., Brooks, Shelby P., and Hamilton, Leslie A.
- Subjects
- *
ANTIBIOTICS , *SEROTONIN syndrome , *COGNITION disorders , *TRAZODONE , *MEDICINAL plants , *DYSARTHRIA , *BODY temperature , *LORAZEPAM , *ISCHEMIC stroke , *SEROTONIN antagonists , *SEROTONIN , *DIFFERENTIAL diagnosis , *PERSPIRATION , *FACIAL paralysis , *ANTIHISTAMINES , *BACTERIAL meningitis , *RISK assessment , *APHASIA , *TREMOR , *VENLAFAXINE , *DRUGS , *MENTAL depression , *BUPROPION , *PLANT extracts , *ANXIETY , *MOUTH , *TISSUE plasminogen activator , *ZIPRASIDONE , *BEDDING , *DISEASE risk factors - Abstract
Introduction: Kratom, an unregulated herbal supplement, has emerged as self-treatment for anxiety/depression. Kratom exhibits inhibition at multiple cytochrome P450 isozymes involved in metabolism of prescription medications, including serotonergic agents. We report a case of possible serotonin syndrome induced by kratom use in combination with prescription psychotropic medications. Case: A 63-year-old male presented with diaphoresis, flushing, aphasia, confusion, dysarthria, right facial droop, and oral temperature of 39.6oC (103.2oF), lactate 2.7 mmol/L, and creatine phosphokinase of 1507 IU/L. Initial differential diagnoses included acute ischemic stroke and bacterial meningitis. Despite partial treatment with alteplase and broad-spectrum antibiotics, symptoms persisted, and subsequent physical exam noted hyperreflexia, clonus, tremors, and temperature of 41.1oC (106oF). Home medications included a chronic regimen for anxiety/depression with bupropion, buspirone, desvenlafaxine, trazodone, and ziprasidone, in addition to kratom. Clinical suspicion for serotonin syndrome led to initiation of cyproheptadine, lorazepam, and cooling blankets. Aphasia, facial droop, and confusion improved after administration of cyproheptadine. Bupropion was restarted during hospitalization; remaining medications restarted at the discretion of the primary care provider. Discussion: Risk of serotonin syndrome with multiple serotonergic agents is well-known. Kratom is metabolized by cytochrome P40 isozymes 3A4, 2C9, and 2D6, and exhibits inhibition at those enzymes, in addition to 1A2. Pharmacokinetic interactions of kratom with prescription serotonergic agents metabolized through these isozymes has the potential to increase systemic exposure of serotonin, potentially leading to serotonin syndrome. Conclusion: Because substances contained in kratom can inhibit metabolism of prescription serotonergic medications, clinicians must be aware of potential development of serotonin syndrome. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
49. Using Interdisciplinary Teams to Mitigate the Effects of Drug Shortages in Palliative Care: The Case of Lorazepam Injection.
- Author
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Hartung, Natalie, Fatima, Zainab, Noreika, Danielle M., Cassel, J. Brian, and Adams, Katie S.
- Subjects
- *
CAREGIVER attitudes , *INVENTORY shortages , *LORAZEPAM , *PHARMACY management , *PHYSICIANS' attitudes , *BENZODIAZEPINES , *PATIENTS' attitudes , *DRUGS , *HEALTH care teams , *INTERPROFESSIONAL relations , *PHYSICIANS , *PALLIATIVE treatment , *TRANQUILIZING drugs , *PATIENT safety - Abstract
Given the rising frequency of drug shortages in hospitals, interdisciplinary collaboration is necessary to manage medications, modify electronic medical records, and evaluate safety outcomes. One such shortage impacted lorazepam injection, a medication commonly used in palliative care to treat anxiety, agitation, and seizures. In anticipation of the lorazepam shortage in the summer of 2022, pharmacy staff collaborated with palliative care physicians to identify alternative treatment recommendations when providers were prohibited from ordering lorazepam injection. Before the shortage, lorazepam was used an average of 95 times per month on the palliative care unit. The overall use of benzodiazepines decreased substantially following the recommendation for the therapeutic alternative, midazolam, during the shortage. Once the shortage ended, use roughly returned to pre-shortage baselines. During this time, there were no patient safety events documented on the palliative care unit. Moreover, no changes to the care experience were reported by patients, family/caregivers, providers, or staff. The collaborative effort between pharmacy and palliative care specialists resulted in alternative treatments for palliative care patients during the drug shortage. This preserved the hospital's supply of lorazepam injection for a patient population with no suitable alternatives while still allowing for management of palliative patients. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
50. Comparison of Droperidol and Midazolam Versus Haloperidol and Lorazepam for Acute Agitation Management in the Emergency Department.
- Author
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Allen, Patrick J., Johanson, Kendra E., Reveles, Kelly R., Neff, Luke A., and Lock, Ashley E.
- Subjects
EMERGENCY room visits ,HOSPITAL emergency services ,MIDAZOLAM ,LORAZEPAM ,HALOPERIDOL - Abstract
Background: Acute agitation accounts for up to 2.6% of visits to the emergency department (ED). To date, a standard of care for the management of acute agitation has not been established. Few studies have evaluated antipsychotic and benzodiazepine combinations. Objective: The purpose of this study was to evaluate effectiveness and safety of combination therapy for acute agitation with intramuscular (IM) droperidol and midazolam (D+M) compared with IM haloperidol and lorazepam (H+L) in patients in the ED. Methods: This was a single-center, retrospective medical record review of patients presenting to a large, academic ED with acute agitation from July 2020 through October 2021. The primary outcome was percentage of patients requiring additional agitation medication within 60 minutes of combination administration. Secondary outcomes included average time to repeat dose administration and average number of repeat doses required before ED discharge. Results: A total of 306 patients were included for analysis: 102 in the D+M group and 204 in the H+L group. Repeat dose within 60 minutes occurred in 7 (6.9%) and 28 (13.8%) patients in the D+M and H+L groups, respectively (P = 0.065). A total of 28.4% of D+M patients and 30.9% of H+L patients required any repeat dose during their ED visit. Time to repeat dose was 12 and 24 minutes in the D+M and H+L, respectively (P = 0.22). The adverse event rate was 2.9% in each group. Conclusion and Relevance: IM D+M resulted in a lower rate of repeat doses of acute agitation medication compared with IM H+L, though this was not statistically significant. Both therapies were safe, and the adverse event rate was low. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
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