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Introduction The intravenous (IV) is one of the main parenteral routes for drug administration. Rapid onset of action, precise titration, patient-specific dosing and bypass of liver metabolism are a few of its advantages, while hypersensitivity reactions, adverse effects, infection risk and a higher overall cost some of its most debated downsides. Unlike other areas of Medicine, IV has been significantly under-utilized in Psychiatry. Objectives This systematic review analyzed the evidence for effectiveness and safety behind the use of IV medication used for the management of acute disturbance. Methods APA PsycINFO, MEDLINE, and EMBASE databases were searched for eligible studies. Studies were included if they used IV medication to treat acute disturbance, in English language, had participants aged >18. The quality of the included studies was assessed using the National Institutes of Health quality checklist. Results 17 studies were deemed eligible. Data analysis was limited to narrative synthesis since primary outcome measures varied significantly between each study. Findings showed strong evidence for efficacy and safety of dexmedetomidine, droperidol, midazolam, and olanzapine. These medications displayed a short time to sedation, reduction in agitation levels, or large percentage of patients adequately sedated with a low number of adverse events. Results did not provide enough evidence for the use of IV ketamine, haloperidol, diazepam, lorazepam, and promethazine. Conclusions This review supports dexmedetomidine, droperidol, midazolam, and olanzapine as safe and efficacious options for managing acute disturbance via the intravenous route, particularly in special clinical settings where trained staff, optimal monitoring, resuscitation equipment and ventilators are all at hand.

We examined the association between the duration of untreated psychosis and outcome for patients with delusional infestation. This multi-centre international study included 211 consecutive patients. Illness severity was evaluated at first presentation and outcome was measured with the Clinical Global Impression scale (CGI) at baseline and follow-up. A regression analysis showed a clear clinical and statistically significant association between shorter duration of untreated psychosis and better outcome at follow-up. Patients with a duration of untreated psychosis of less than one year showed a CGI-S change from 5.37 to 2.07; those with a duration of untreated psychosis of 1–5 years a change from 5.48 to 2.59, and those with a duration of untreated psychosis of >5 years a change from 5.59 to 3.37. This difference of 1.1 CGI points between the groups resembles a clinically relevant difference in patient outcome. Our results suggest that longer duration of untreated psychosis in patients with delusional infestation is associated with significantly less favour­able clinical outcomes.

Introduction: The intravenous (IV) is one of the main parenteral routes for drug administration. Rapid onset of action, precise titration, patient-specific dosing and bypass of liver metabolism are a few of its advantages, while hypersensitivity reactions, adverse effects, infection risk and a higher overall cost some of its most debated downsides. Unlike other areas of Medicine, IV has been significantly under-utilized in Psychiatry. Objectives: This systematic review analyzed the evidence for effectiveness and safety behind the use of IV medication used for the management of acute disturbance. Methods: APA PsycINFO, MEDLINE, and EMBASE databases were searched for eligible studies. Studies were included if they used IV medication to treat acute disturbance, in English language, had participants aged >18. The quality of the included studies was assessed using the National Institutes of Health quality checklist. Results: 17 studies were deemed eligible. Data analysis was limited to narrative synthesis since primary outcome measures varied significantly between each study. Findings showed strong evidence for efficacy and safety of dexmedetomidine, droperidol, midazolam, and olanzapine. These medications displayed a short time to sedation, reduction in agitation levels, or large percentage of patients adequately sedated with a low number of adverse events. Results did not provide enough evidence for the use of IV ketamine, haloperidol, diazepam, lorazepam, and promethazine. Conclusions: This review supports dexmedetomidine, droperidol, midazolam, and olanzapine as safe and efficacious options for managing acute disturbance via the intravenous route, particularly in special clinical settings where trained staff, optimal monitoring, resuscitation equipment and ventilators are all at hand. [ABSTRACT FROM AUTHOR]

Introduction: Physicians in general hospitals are frequently faced with decisions regarding the psychopharmacologic management of medically ill patients, yet receive limited psychiatric training and leading to interruption of psychiatric treatment. Literature demonstrate high rates of relapse when medications are discontinued in patients suffering from schizophrenia, mood and anxiety disorders. Objectives: The aim of this study is to compare interruption of psychopharmacologic treatment in a general hospital between surgery department and Internal medicine department. Methods: 373 consecutive consultations to a Liaison Psychiatry Service of a General Hospital (Barcelona) were registered during 1year. Consultations from Surgery and Internal Medicine departments were selected with a total sample of 56. Demographic characteristics of patients, clinical data and main pharmacological treatment were recorded through an "ad hoc" questionnaire. Database information was completed with electronic medical records. Comparative analysis was performed with SPSS using Chi-Square Test for qualitative variables and t-Student test for continuous variables Results: From a total of 373 consultations, 30%(8.0%) were from Internal medicine department and were from 26(7%) general surgery. The diagnosis found were similar in both departments. Interruption of treatment was detected in 17.24% of the Internal Medicine consultations and 18.18% of the Surgery consultations. The treatment most interrupted were antidepressants(55.5% from total interrupted treatments). Conclusions: According to our results there are differences in treatment interruption between psychotropic drugs and internal Medicine and surgery admissions. It is important to apply specific programs and adjust protocols in each department, involving Psychiatry Liaison service to help physician making complex psychopharmacologic decisions and to improve mental health patient's treatment. [ABSTRACT FROM AUTHOR]

Introduction: In general hospitals the presence of mental health disorders in hospitalized patients is a common problem. Patients with comorbid mental illnesses display increased morbidity and mortal and thus leads to an increased risk of prolonged and repeated hospital stays. Objectives: The aim of this study is to describe in a general hospital which departments request Psychiatry Liaison service consultation and sociodemographic and clinical characteristics of the assessed patients. Methods: Consecutive consultations to a Liaison Psychiatry Service of a General Hospital (Hospital del Mar, Barcelona) were registered from August 2018 to August 2019 with a total sample of 373. Demographic characteristics of patients, clinical data and main pharmacological treatment were recorded through an "ad hoc" questionnaire. Database information was completed with electronic medical records. Comparative analysis was performed with IBM SPSS Statistics (Chicago INC) using Chi-Square Test for qualitative variables and t-Student test for continuous variables. Results: From a total of 373 consultations, 30(8.0%) were from Internal medicine department, 26(7%) general surgery, 27(7.2%) Pneumology, 58(15.5%) Emergency department, 29(7.8%) Nephrology, 19(5.1%) Cardiology, 18(4.8%) Oncology, 15(4.0%) Intensive care unit, 17(4.6%) Anaesthesiology, 16(4.3%) Neurology, 15(4.0%) Infectious disease, among others. The most diagnosis treated was adjustment disorder(21.2%) and acute confusional syndrome (17.3%) with significant differences between services. Conclusions: According to our results there are differences in mental health diagnosis depending of consultant department in our general hospital. Thus, it is important to apply specific programs and adjust protocols in each department to improve mental health patient's assessment. [ABSTRACT FROM AUTHOR]

Introduction: Fibromyalgia is usually treated by our colleagues in Rheumatology or specialists in Pain Management from Internal Medicine or Anesthesiology, but as psychiatrists we also encounter many patients with the syndrome. Besides suffering from pain, these patients frequently report fatigue, sleep disturbances, cognitive difficulties, depressed mood and anxiety. Considering the frequency and intensity of these symptoms, as well as the role of affect on neurobiological pain modulation, psychiatrists working with these patients should be able to understand and provide adequate treatment. Objectives: To elucidate a psychiatrist's contribution to the treatment of fibromyalgia. Methods: An extensive search on Pubmed was conducted, using the terms "fibromyalgia", "psychiatrist", "psychiatry", "depression" and "anxiety". Relevant articles with available full text were consulted, as well as other references from reputable sources. Results: Psychiatrists should be a part of multidisciplinary teams for the treatment of patients with chronic pain, including those with fibromyalgia, as psychiatric symptoms are a common feature. Improvement of psychiatric symptoms may ameliorate pain as well, and possible interventions may range from psychopharmacology to psychotherapy. Conclusions: Fibromyalgia requires a multidisciplinary approach. Psychiatrists should be integrated in Pain Management groups and be familiar about how they can contribute to these patients' wellbeing. [ABSTRACT FROM AUTHOR]

We examined the association between the duration of untreated psychosis and outcome for patients with delusional infestation. This multi-centre international study included 211 consecutive patients. Illness severity was evaluated at first presentation and outcome was measured with the Clinical Global Impression scale (CGI) at baseline and follow-up. A regression analysis showed a clear clinical and statistically significant association between shorter duration of untreated psychosis and better outcome at follow-up. Patients with a duration of untreated psychosis of less than one year showed a CGI-S change from 5.37 to 2.07; those with a duration of untreated psychosis of 1-5 years a change from 5.48 to 2.59, and those with a duration of untreated psychosis of >5 years a change from 5.59 to 3.37. This difference of 1.1 CGI points between the groups resembles a clinically relevant difference in patient outcome. Our results suggest that longer duration of untreated psychosis in patients with delusional infestation is associated with significantly less favour-able clinical outcomes.