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2 results

  • Chapter 32 - Psychiatric Care of the Medical Patient

  • Edited by Marsal Sanches, McGovern Medical School, Texas, Jair C. Soares, McGovern Medical School, Texas
  • Book:
    Fundamentals of Clinical Psychiatry
    Published online:
    02 January 2025
    Print publication:
    16 January 2025, pp 326-338

  • Summary

    Psychiatrists are often called to see nonpsychiatric patients in medical settings. Two potential reasons for a consult are neuroleptic malignant syndrome and serotonin syndrome; both are potential emergencies. They differ in cause and pathophysiology. However, they have certain things in common: Both are rare and may go unrecognized or misdiagnosed. In addition, the course of both syndromes depends on the speed of intervention, and delays can result in lasting complications or mortality. This chapter reviews the features of each syndrome, the diagnosis and differential, and the recommended treatment approaches.

  • Use of atomoxetine and suicidal ideation in children and adolescents: Results of an observational cohort study within general practice in England

  • M. Davies, A. Coughtrie, D. Layton, S.A.S. Shakir
  • Journal:
    European Psychiatry / Volume 39 / January 2017
    Published online by Cambridge University Press:
    23 March 2020, pp. 11-16
  • Aim

    To investigate the association between atomoxetine, a drug used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD), and suicidal ideation, within a cohort of 2–18-year-old patients in England.

    Methods

    The study was conducted using the observational cohort technique of Modified prescription event monitoring (M-PEM). Patients prescribed atomoxetine were identified from dispensed prescriptions issued by primary care physicians. A customised postal GP questionnaire was used to capture outcome data for suicidal ideation. A matched pair cohort analysis was performed within patients to compare the risk of suicidal ideation in the period after starting atomoxetine with the risk prior to starting atomoxetine; this was stratified by age and concomitant use of methylphenidate. Additional information on patient characteristics, and events of interest was also collected; individual cases of suicidal ideation were qualitatively assessed for drug relatedness.

    Results

    Of the final cohort (n = 4509); 85.5% male (n = 3857), median age 11 years (IQR: 9,14). Primary prescribing indication for atomoxetine was ADHD (n = 4261, 94.6%). Almost a quarter of the cohort had been co-prescribed methylphenidate. Results of the matched pair cohort analysis indicated that the period after starting atomoxetine was not associated with an increase in the incidence of suicidal ideation compared to the period prior to starting treatment (RR: 0.71; CI: 0.48–1.07; P-value: 0.104). Individual case assessment of suicidal ideation suggested a causal association within a number of cases.

    Conclusions

    This study found no evidence of an increased risk of suicidal ideation during treatment with atomoxetine, compared to the period prior to starting treatment. Amongst age specific subgroups, this risk may change. Nonetheless, individual case assessment suggested a causal relationship in some patients, hence physicians need to be aware of the possibility of developing this event, and furthermore consider how best to detect it in this paediatric population. This study demonstrates the importance of combining quantitative statistical analyses with a qualitative case series assessment.