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Biomedical subjects

W R Dubin

Publications and source records attributed to W R Dubin.

At least 19 recordsLinked to original sources
PubMed1996

Threats against clinicians: a preliminary descriptive classification.

Threats against psychiatrists are common, but existing studies on the subject lack descriptive information about the nature and resolution of the threat. In the present study, clinicians who had received threats were interviewed in person or by telephone, and case histories were summarized. Threats were classified as situational and transferential. Demographic factors, precipitating events, and legal actions taken are described. The manner in which clinicians reacted to threats is also discussed.

Adult↗
PubMed1990

Electroconvulsive therapy and major depression in Down's syndrome.

The authors treated two patients who had Down's syndrome and major depression with a combination of inpatient and outpatient electroconvulsive therapy (ECT). They found only 10 other similar published cases, although none involved outpatient ECT. Their experience, in conjunction with that reported in the literature, indicates that ECT is a safe and effective treatment for depressed mentally retarded individuals, including those who respond poorly to antidepressants.

Adolescent↗
PubMed1990

An efficacy study of single- versus double-seizure induction with ECT in major depression.

Twenty-nine patients with major depression, with and without psychosis, were randomly assigned to bilateral conventional electroconvulsive therapy (ECT) or modified multiple monitored ECT (MMECT) limited to two seizure inductions in a session. From pretreatment to after the fourth treatment session, modified MMECT was associated with more rapid amelioration of depressive symptoms on the basis of blindly rated Hamilton Rating Scale for Depression scores. No medical complications occurred. Sixty-two percent of patients in the modified MMECT group had posttreatment confusion, whereas 15% of patients treated with conventional ECT were confused. Modified MMECT appears to confer some clinical advantage over conventional ECT in the treatment of major depression while carrying an increased risk of treatment-related reversible confusion.

Clinical Protocols↗
PubMed1989

Rapid tranquilization of the violent patient.

Agitated, psychotic patients with the potential for violence pose significant management problems for emergency department staff. With the advent of rapid tranquilization (RT), clinicians were offered a safe, effective method for controlling such patients, eliminating the need for restraints or seclusion rooms. While RT is regarded as a major treatment innovation in psychiatry, nonpsychiatrists are reluctant or unaware of the uses of antipsychotic medication as it pertains to RT. This article provides a brief overview of the pharmacokinetics of antipsychotic medication and reviews the following aspects of RT: route of administration, dosing, time intervals between doses, side effects, and alternative medications for RT. The authors also offer practical guidelines for RT use in the emergency department.

Antipsychotic Agents↗
PubMed1989

The role of fantasies, countertransference, and psychological defenses in patient violence.

Over the past decade the management of aggression on psychiatric units has generally focused on pharmacologic and physical interventions rather than on psychodynamic concerns. The author reviews the dynamics of violence and discusses how clinical staff's fantasies, countertransferences, and psychological defenses may interact to trigger patient aggression. Interventions that address these issues with staff include developing a cohesive treatment team in which clinical staff can express their feelings without the need to explore the psychodynamic underpinnings, having clinical leaders maintain a strong presence on the unit to serve as role models, and providing regular inservice training.

Conflict, Psychological↗
PubMed1988

Rapid tranquilization: antipsychotics or benzodiazepines?

With the advent of rapid tranquilization (RT), psychiatrists were able to intervene quickly and effectively with psychotic, agitated, and potentially assaultive patients. As RT often obviated the need for physical restraints, it became a mainstay in emergency psychiatry. While studies have repeatedly demonstrated the safety and efficacy of antipsychotic medication to achieve RT, there has been some concern about potential untoward side effects, such as neuroleptic malignant syndrome, tardive dyskinesia, and extrapyramidal symptoms. As a result, many investigators have begun exploring alternatives to the use of antipsychotics for RT. Benzodiazepines are among the classes of drugs most often discussed. The author reviews the current literature on both antipsychotics and benzodiazepines and summarizes the results of several extensive reviews of RT that have appeared in the past few years. The author also critically examines the literature on the use of benzodiazepines for RT, with emphasis on lorazepam and clonazepam. Finally, the author proposes tentative guidelines for RT and directions for future clinical research.

Acute Disease↗
PubMed1988

Assaults against psychiatrists in outpatient settings.

Questionnaires were sent to 3800 psychiatrists in Pennsylvania, New Jersey, and Delaware to investigate assaults against psychiatrists in outpatient settings. Ninety-one questionnaires were returned: 32 psychiatrists reported serious assaults (gun or knife), and 59 reported less serious assaults (object or physical attack). Significantly more personal injury and property damage resulted from the less serious assaults. Coping strategy was significantly related to the type of assault; positive verbal intervention was the most effective. Thirty-one (36%) of 87 respondents stated that they had moderate to strong feelings before the attack that the patient was potentially violent. Experienced psychiatrists were as likely to be victims of assault as were inexperienced psychiatrists. Forty-eight (59%) of 81 psychiatrists continued to treat the patients who had assaulted them. Only 20 (23%) of 87 psychiatrists had security arrangements at the time of the assault. The authors present four case vignettes which typify the different types of assaults, interventions, and outcomes.

Adaptation, Psychological↗
PubMed1986

Sudden unexpected death: intervention with the survivors.

Sudden unexpected death is a traumatic event for surviving family and friends. When the survivors learn of their loss, they react with turmoil and disbelief. Intervention with the survivors is essential to facilitate a normal grieving process. To provide emergency staff with guidelines, we review the dynamics of grief and discuss intervention in the following six phases: contacting the survivors; arrival of the survivors; notification of death; the grief response; viewing the body; and the concluding process. We conclude with a discussion of intervention with children.

Adult↗
PubMed1986

The psychiatric short procedure unit: a cost-saving innovation.

Dr. Sharfstein's Introduction: As the rules of reimbursement are being rewritten, it is important that psychiatrists create clinical innovations that make sense from both an economic and a quality-of-care perspective. The psychiatric short procedure unit is such an innovation. As described by the authors of this month's column, it also conceptualizes a new role for the psychiatric emergency service. The short procedure unit not only provides relief for the financial troubles of the psychiatric emergency service but also promises to be a cost-effective option to 24-hour inpatient hospital care.

Adult↗
PubMed1986

Pharmacotherapy of psychiatric emergencies.

The psychiatric emergency service has become a major provider of psychiatric care over the past decade. Concomitant with this growth has been an emphasis on pharmacological treatment. While rapid tranquilization is the best known and most frequently used intervention, a growing diagnostic awareness has led to a variety of other chemotherapeutic approaches. The current reviews of pharmacologic intervention in the psychiatric emergency service do not detail the variability of treatment approaches or examine alternative treatment approaches. The goal of this article is to critically review current pharmacologic treatments and address areas in which there is no consensus in treatment approach. From this review the authors suggest guidelines for pharmacotherapy of psychiatric emergencies. The authors discuss rapid tranquilization, the treatment of alcohol and drug intoxication and withdrawal, and anxiety disorders.

Amphetamines↗
PubMed1986

Rapid tranquilization: a comparison of thiothixene with loxapine.

This 6-day study evaluated the efficacy of equivalent doses of loxapine and thiothixene for rapid tranquilization of acutely disturbed, psychotic patients. After initial tranquilization with intramuscular injections for 24 hours, 58 patients were treated for 5 days with oral medication. With both drugs, intramuscular treatment demonstrated clinically significant improvement from baseline on Clinical Global Impressions and Brief Psychiatric Rating scales; this improvement continued during the oral phase. Median time to tranquilization was significantly less with loxapine (60 minutes) than with thiothixene (95 minutes); during the oral phase, there were no significant differences between the two treatment groups. Side effects were minimal during the intramuscular phase; dystonia was most common during the oral phase.

Administration, Oral↗