Biomedical subjects

M G Farnsworth

Publications and source records attributed to M G Farnsworth.

5 recordsLinked to original sources

PubMed2001

Clinical effects of a randomized switch of patients from clozaril to generic clozapine.

INTRODUCTION: Clozapine was discovered in 1959 but withheld from the United States market after several deaths due to agranulocytosis. The medication was approved in the United States in 1989 on a compassionate-use basis and was first marketed in 1990 as Clozaril. In 1999, following approval by the U.S. Food and Drug Administration, Zenith Goldline Pharmaceuticals (ZGP) introduced a generic form of clozapine. METHOD: After 5 weeks of data collection (phase I), 24 patients were randomly assigned to group A and 21 patients to group B. Patients had DSM-IV diagnoses of schizophrenia, schizoaffective disorder, bipolar disorder with psychosis, or atypical psychosis with mood disorder. In phase II, group A received a mean daily dose of 630 mg of generic clozapine, and group B continued to receive Clozaril at a mean daily dose of 610 mg, each for 8 weeks. In phase III, group A was reassigned to Clozaril, and group B was switched to generic clozapine, each for 8 weeks. At the end of phase III, group B resumed Clozaril. Efficacy was measured with the Clinical Global Impressions-Improvement (CGI-I) scale, the Brief Psychiatric Rating Scale (BPRS), and the Beck Depression Inventory (BDI). RESULTS: Five patients experienced relapse when they were switched from Clozaril to generic clozapine. Eleven patients worsened short of full relapse, 9 while receiving ZGP generic clozapine and 2 while receiving Clozaril. CGI-I scores and BPRS scores favored patients receiving Clozaril significantly. Only BDI scores favored patients receiving generic clozapine significantly. CONCLUSION: Until more studies have been performed, clinicians and administrators should carefully monitor stable Clozaril-treated patients who are being switched to generic clozapine.

Adult↗

PubMed1991

The impact of judicial review of patients' refusal to accept antipsychotic medications at the Minnesota Security Hospital.

In 1988, the Minnesota Supreme Court ruled that premedication judicial review was required to force antipsychotic medications on incompetent committed patients in Minnesota. Before this decision all patients refusing antipsychotic medications at state hospitals were reviewed by an internal multidisciplinary peer review organization called the Treatment Review Panel (TRP). The author examined the impact of judicial review of medications at the Minnesota Security Hospital. Thirty-one patients reviewed by the Treatment Review Panel (TRP) between July 1986 and December 1987 were compared with 37 patients reviewed by the TRP and the court between January 1988 and December 1989. There was nearly unanimous agreement between the TRP and the court in approving antipsychotic medications for patients. However, for patients awaiting judicial review for medication, an average delay of 80 days was encountered, and there was a significant increase in the number of emergencies occurring on the treatment unit before the initiation of treatment. Complications of the long delay in approving medications included the diversion of limited mental health money to cover the costs of judicial review, diversion of physicians from direct patient care to provide testimony, inconsistent judicial medication and monitoring decisions, and compromise of medical judgment to meet judicial requirements. The study concluded that there was no advantage of judicial review over the previous Treatment Review Panel function.

Adult↗

PubMed1990

Competency evaluations in a general hospital.

This study describes 90 requests for competency evaluation received by a psychiatry consultation service between 1983 and 1986. Most of the requests were prompted by a patient's refusal to accept a physician's recommendations regarding treatment or disposition. Delirium and dementia accounted for the majority of diagnoses in the population deemed incompetent. Consultees were more likely to follow recommendations for further medical evaluation than to obtain recommended guardianships, living-skill assessments, or neuropsychometric testing. Guardianships were established for only seven of 26 patients deemed incompetent. This study demonstrates the need for consulting psychiatrists to be aware of the forensic issues of competency.

Female↗

PubMed1990

Benzodiazepine abuse and dependence: misconceptions and facts.

Benzodiazepines can be prescribed for a number of medical conditions. Many physicians are reluctant to prescribe benzodiazepines out of fear of producing dependence in patients and incurring the disapproval of their peers. Studies of psychotropic drug use and abuse demonstrate that individuals using benzodiazepines for treatment of a medical illness rarely demonstrate tolerance to the therapeutic action of the medication or escalate the dose. Eighty percent of benzodiazepines are prescribed for 6 months or less, and elderly women are the most common long-term users of low-dose benzodiazepines. In contrast, recreational use of benzodiazepines is associated with polysubstance abuse, lack of medical supervision, rapid tolerance to the euphoric or sedating side effect, and escalation of dose. Most recreational users of benzodiazepines are young men. Documentation of indication for use, collection of drug-abuse history, close monitoring, and drug holidays can improve the management of this class of medication.

Adult↗

PubMed1989

Evaluation of mental competency.

The assessment of competency is a legal and judicial one, often resting heavily on a medical evaluation. According to one set of criteria, the primary elements of mental competency are based on an individual's awareness of the nature of the present situation, factual understanding of the issues at hand and ability to manipulate information rationally to reach a decision. Family physicians can play pivotal roles in the process of competency determination.

Activities of Daily Living↗