Psychiatry MMC

Psychiatry 2005 - ISSN: 1550-5952 - Volume 2 - Issue 8 - August 2005
Evidence-Based Pharmacology:
The Potential Risks of Commonly Prescribed Antipsychotics During Pregnancy and Lactation
by Mohammad Masud Iqbal, MD, MPh, MSPh, DTM; Alka Aneja, MD, MA; Atiq Rahman, MD, DrPh, MPh; James Megna, MD, PhD; Wanda Freemont, MD; Mohammed Shiplo, BS; Nikil Nihilani, MD; and Kathy Lee, MD

ABSTRACt Chlorpromazine, haloperidol, fluphenazine, clozapine, risperidone, quetiapine, olanzapine, ziprasidone, and aripiprazole are antipsychotics commonly used in psychiatric medicine. Approximately one third of pregnant women with psychotic symptoms use antipsychotics at least once. This review will discuss the effects of antipsychotic use during pregnancy and lactation on the fetus and infant. Although adequate and well-controlled studies have not been done in any one of these antipsychotic drugs, animal studies have revealed evidence of teratogenic or embryo/fetotoxic effects in all of them. Toxicities include skeletal malformations, central nervous system (CNS) defects, cleft palate, cardiac abnormalities, decreased fetal growth, and fetal death. For example, in pregnant women, congenital malformations and perinatal death have been reported with chlorpromazine use. Both chlorpromazine and fluphenazine in monotherapy have been shown to cause extrapyramidal symptoms and respirat

Feature Article:
Pediatric Psychotropic Polypharmacy
by Mark R. Zonfrillo, MD; Joseph V. Penn, MD; and Henrietta L. Leonard, MD

Study Objective: This study was a literature review designed to assess the rates of psychotropic �polypharmacy� in the pediatric population. Psychotropic polypharmacy was defined as the practice of prescribing two or more medications (e.g. concomitant psychotropic medications) for one or more diagnosed psychiatric conditions and/or behavioral symptoms. Methods: A literature review of relevant articles pertaining to polypharmacy was completed using the Pub Med database from 1994 through April 2004 for pediatric populations under 18 years old. Results: Studies were reviewed from various pediatric settings. While the extent of polypharmacy varied from the different populations, all the studies comparing these rates across time showed an increase in this practice. The use of stimulants with another psychotropic medication was the most frequent combination. Conclusions: There is limited information about the actual rates of psychotropic polypharmacy in the pediatric population. Howeve
Growing Up Whole: Somali Children and Adolescents in America
by Deborah L. Scuglik, MD; and Renato D. Alarcon, MD, MPH

ABSTRACt Objective: This is the second phase of a study aimed at determining the cultural characteristics, psychiatric needs, acculturative stressors, and management approaches of immigrant Somali children�s experience in the United States. Methods: A 10-year demographics review of the Minnesota Departments of Human Services, and Children, Families, and Learning was completed. Data was obtained through unstructured interviews with educational staff, healthcare providers, and Somali children and their families in three communities, regarding cultural characteristics, barriers to care, perceptions of medical/psychiatric needs, and issues of acculturation. Health professionals/psychiatrists at a tertiary care center were also surveyed. Results: Identified acculturation issues of adolescent Somali immigrants included acculturative stress, racial discrimination, khat use, legal difficulties, language barriers, school opportunities, changes in family dynamics and developmental issues, clini
Quality of Life of Children and Adolescents During Psychiatric Treatment in a Community Mental Health Setting
by Leo Bastiaens, MD; and Cathy Dello Stritto, RN

abstract The objective of this study was to measure level of functioning and quality of life in children and adolescents undergoing psychiatric treatment. The design was prospective, with measurements at baseline, three months, and one year. The setting was a community mental health center. Participants comprised 89 patients, between the ages of 5 and 18, with a variety of diagnoses. The Global Assessment of Functioning Scale, Columbia Impairment Scale, and the Health and Life Functioning Scale were used as outcome measures. Results showed that level of functioning and quality of life significantly improved after three months. However, these variables did not show any further substantial change after one year. The authors conclude that, despite initial improvements, level of functioning may be suboptimal and quality of life measures may identify patients who will require more than �treatment as usual.�

Forensic Files:
Civil Commitment: A Power Granted to Physicians by Society
by Seth Feuerstein, MD, JD; Frank Fortunati, MD, JD; Charles A. Morgan, MD, MA; Vladimir Coric, MD; Humberto Temporini, MD; and Steven Southwick, MD

Journal Watch:
Pediatrics and Psychiatry
Laura Alexander

Letters to the Editor:
Vectored electroencephalograms
Jim Sondecker, BS, MS; M. Smith, MD; D. Robinson, DO
The DSM-V: Simplify, clarify
Lorraine S. Roth, MD
On pathological gambling
Lewis H. Lipsius, MD

News & Trends:
August 2005 News & Trends
Psych Rx:
August Psych Rx
Psychotherapy Rounds:
Management of Depression During Pregnancy and the Postpartum Period
by Brenda Roman, MD; and Ann Morrison, MD