Deprescribing antipsychotics: a guide for clinicians

2018 ◽  
Vol 24 (5) ◽  
pp. 295-302 ◽  
Author(s):  
Swapnil Gupta ◽  
John Daniel Cahill ◽  
Rebecca Miller
Keyword(s):  
Learning Objectives ◽  
List Type ◽  
Benefit Analysis ◽  
Antipsychotic Medications ◽  
Know How ◽  
Risks And Benefits ◽  
Key Points ◽  
Key Steps ◽  
Risk Benefit Analysis

SUMMARYPolypharmacy and the risks of long term use of antipsychotic medications point toward the need for identifying practices for deprescribing in psychiatry. The following article gives a brief overview of key points around deprescribing antipsychotic medications in psychiatry, including identifying risks and benefits, considerations around timing, and steps involved.LEARNING OBJECTIVES•Be able to define the concept of deprescribing as it relates to antipsychotic medications•Know how to perform a risk–benefit analysis for a patient on antipsychotic medication•Be able to identify the key steps involved in deprescribing antipsychotic medicationsDECLARATION OF INTERESTNone.

Part IX Costs, Funding, and Ideas for Optimization, 28 Optimizing the use of Mediation in International Arbitration: A Cost–Benefit Analysis of ‘Two Hat’ Versus ‘Two People’ Models

2016 ◽  
Author(s):  
Waincymer Jeffrey
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Dual Role ◽  
Benefit Analysis ◽  
Dual Roles ◽  
Party Autonomy ◽  
Key Points ◽  
Fairness And Efficiency ◽  
Full Cooperation

This chapter considers the question of whether an arbitrator may also adopt a mediation function or whether the dual roles are antithetical. It tests that hypothesis by engaging in a cost-benefit analysis of differing scenarios when mediation is utilized in an arbitral context. The prime comparison is between parallel mediation with a separate neutral and the alternative of a dual-role neutral. The three key points are: there should be much more mediation occurring at the international level, regarding both potential and actual arbitral disputes; a commercially minded arbitrator concerned for the parties’ good faith should encourage mediation where appropriate, in particular, when an adjudicated outcome will not be in the interests of either, usually because the dispute is a small part of a long-term relationship that can risk that relationship no matter who wins; and, while informed party autonomy should always support a dual-role neutral, in most factual permutations, informed parties could be expected to prefer parallel mediation provided there is full cooperation between mediator and arbitrator. The chapter argues that the relative benefits of the use of dual-role neutrals would be greatly outweighed by the costs in fairness and efficiency, and the inevitable need for a sub-optimal design of either or both dispute processes. The benefits would also be separately outweighed by the risks of significant disruption to any ensuing arbitration if a dual-role neutral fails to achieve a settlement.

A Concept for Long-Term Anticoagulation Based On the Individual Risk of Lethal Pulmonary Embolism (PE) and Lethal Bleeding Using Oral Anticoagulants.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4174-4174
Author(s):  
Rainer B. Zotz ◽  
Christoph Sucker ◽  
Andrea Gerhardt
Keyword(s):  
Risk Factors ◽  
Oral Anticoagulation ◽  
Factor V Leiden ◽  
Bleeding Risk ◽  
Individual Risk ◽  
Factor V ◽  
Benefit Analysis ◽  
Initial Event ◽  
Risk Benefit Analysis

Abstract Abstract 4174 Objectives Indications for an indefinite oral anticoagulation are a matter of debate in patients with a first unprovoked proximal DVT. Methods An individual risk-benefit analysis is made using published prospective studies by determining the patient-specific lethal risk of bleeding under oral anticoagulation compared with the estimation of lethal PE-risk by type of initial thrombosis (spontaneous vs. secondarily caused, with or without PE). Results According to this risk-benefit analysis, long-term oral anticoagulation is indicated to prevent lethal PE in all patients with low risk of bleeding (1% per year, 0.1 % lethal bleeding per year) in the risk group with lethal PE > 0.2 % per year. This risk group includes patients with idiopathic proximal thrombosis and PE in the initial event (also without thrombophilic risk factors) and patients with an idiopathic initial event without PE, who have relevant thrombophilic risk factors with a relative risk ≥ 2, such as antithrombin deficiency, homozygous factor V Leiden or a combined heterozygous factor V Leiden and prothrombin G20210A mutation. In case of a higher bleeding tendency (0.3% lethal bleeding per year in a patient group with 1-2 bleeding risk factors like age >65 or diabetes) other risk-benefit estimations are present. Conclusions Our individual risk stratification is in contrast to current therapy recommendations, which generally consider long-term oral anticoagulation for patients with an idiopathic initial proximal DVT with a low bleeding risk, but do not specify these in individual cases. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Health anxiety: detection and treatment

2018 ◽  
Vol 24 (1) ◽  
pp. 66-72 ◽  
Author(s):  
Peter Tyrer ◽  
Helen Tyrer
Keyword(s):  
Health Anxiety ◽  
Behavioural Therapy ◽  
Learning Objectives ◽  
List Type ◽  
Psychological Treatments ◽  
Cognitive Behavioural ◽  
New Diagnosis ◽  
Changing Attitudes ◽  
Term Benefit

SUMMARYHealth anxiety is an important new diagnosis that is increasing in frequency because of changing attitudes towards health, particularly excessive use of health information on the internet (cyberchondria). People with abnormal health anxiety become over-diligent monitors of their health, misinterpret most somatic sensations as evidence of disease, consult medical professionals unnecessarily and frequently, and are often over-investigated. Relatively few patients with health anxiety present to psychiatrists; most are seen in primary and secondary medical care. This paper reviews the diagnosis and presenting features of health anxiety, its identification in practice and its treatment. A range of simple psychological treatments have been shown to have long-lasting benefit for the disorder but are greatly under-used.LEARNING OBJECTIVES•To be able to identify abnormal health anxiety with the aid of probe questions•To respond to people whom you have identified with excessive health anxiety in a way that facilitates its treatment•To learn a few simple techniques derived from cognitive–behavioural therapy that can lead to long-term benefitDECLARATION OF INTERESTNone.

scholarly journals Digital Subscription Systems in the Face of COVID-19 Crisis: The Case of ‘El Mundo’

Tripodos ◽  
2021 ◽  
Vol 2 (47) ◽  
pp. 87-102
Author(s):  
Enrique Canovaca de la Fuente
Keyword(s):  
Economic Recession ◽  
Know How ◽  
Key Points ◽  
Depth Analysis ◽  
The Face ◽  
The Media ◽  
Long Term Consequences ◽  
Revenue Models ◽  
The Impact

The aim of this article is to analyse the impact of COVID-19 on the income models of the Spanish general inter­est press through an in-depth analysis of the case of ‘El Mundo’. This article shows data about the decline in adver­tising, both in printed and digital for­mats, during the first quarter of 2020 and, more specifically, during March. It also reveals that the media platforms with a previously implemented sub­scription system have gained a signif­icant number of new registrations. Not only is ‘El Mundo’ an example of this trend, but also other newspapers such as ‘Eldiario.es’, ‘Ara’, ‘La Razón’ or ‘La Voz de Galicia’. The reader becomes an alternative to lessen advertising losses at a time of global transformation of the industry towards reader-revenue models. Long-term consequences of a probable economic recession once the pandemic effects are reduced are also considered in the analysis. The article also outlines some key points to ensure the viability of newspaper publishers, such as investing in journalists with relevant sources or profiles that know how to manage new digital businesses. Keywords: COVID-19, press, business, subscriptions and advertising.

scholarly journals Nutritional Importance of Selected Fresh Fishes, Shrimps and Mollusks to Meet Compliance with Nutritional Guidelines of n-3 LC-PUFA Intake in Spain

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 465
Author(s):  
Maria Dolores Mesa ◽  
Fernando Gil ◽  
Pablo Olmedo ◽  
Angel Gil
Keyword(s):  
Fatty Acids ◽  
Fatty Acid Content ◽  
Benefit Analysis ◽  
Fatty Fish ◽  
Pufa Intake ◽  
Risks And Benefits ◽  
Nutritional Guidelines ◽  
Potential Risks ◽  
Fishery Products ◽  
Risk Benefit Analysis

Fishery products are the main source of dietary n-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFA). Following the European Commission’s request to address the risks and benefits of seafood consumption, and taking into account the great variability of nutrient and contaminant levels in fishery products, the present work aims to estimate the n-3 LC-PUFA provided per serving of selected fishes, shrimps and mollusks that are commonly consumed in Spain. This would enable the establishment of a risk–benefit analysis of fish consumption and provide recommendations for fish intake to comply with nutritional guidelines of n-3 LC-PUFA intake. We confirmed high variation in the pattern and contents of fatty acids for different species. n-6 PUFA were minor fatty acids, whereas palmitic (C16:0), oleic (C18:1 n-9), and mainly eicosapentaenoic (C20:5 n-3) and docosahexaenoic (C22:6 n-3) acids were the major fatty acids in the sample. Therefore, consumption of 2–3 servings per week of a variety of fishery products may contribute to compliance with the recommended daily n-3 LC-PUFA intake while maintaining an adequate balance to avoid contaminant-derived potential risks (metals and others). Taking the fatty acid content of fishery products described in this study into consideration, it is advisable to include one serving of fatty fish per week in order to meet recommended n-3 LC-PUFA levels.

scholarly journals Current understanding of narcissism and narcissistic personality disorder

2018 ◽  
Vol 24 (5) ◽  
pp. 305-315 ◽  
Author(s):  
Jessica Yakeley
Keyword(s):  
Personality Disorder ◽  
Empirical Studies ◽  
Learning Objectives ◽  
Narcissistic Personality Disorder ◽  
List Type ◽  
Pathological Narcissism ◽  
Know How ◽  
Psychological Therapies ◽  
Narcissistic Personality

SUMMARYThis article reviews historical contributions to the conceptualisation of narcissism and narcissistic personality disorder (NPD), including its evolution as a clinical diagnosis within the DSM classification of mental disorders. It discusses the epidemiology and aetiology of NPD, noting that empirical studies of both are limited. The challenges of managing patients with prominent narcissistic traits are presented, and the psychological therapies specifically designed for the treatment of patients with NPD are summarised.LEARNING OBJECTIVES•Understand different models of narcissism•Understand the epidemiology, comorbidity and theories of aetiology of NPD•Know how to manage and treat patients with pathological narcissism and NPDDECLARATION OF INTERESTNone.

A long-term risk-benefit analysis of low-dose aspirin in primary prevention

2016 ◽  
Vol 46 (2) ◽  
pp. 130-140 ◽  
Author(s):  
I-Chen Wu ◽  
Hui-Min Hsieh ◽  
Fang-Jung Yu ◽  
Meng-Chieh Wu ◽  
Tzung-Shiun Wu ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Low Dose ◽  
Benefit Analysis ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Risk Benefit Analysis

Medicare Item 319 after 10 Years: A Range of Concerns

2007 ◽  
Vol 15 (5) ◽  
pp. 372-374 ◽  
Author(s):  
Gil Anaf ◽  
Paul Jewell
Keyword(s):  
Medical Records ◽  
Global Assessment ◽  
Self Esteem ◽  
Benefit Analysis ◽  
Global Assessment Of Functioning ◽  
Access To Treatment ◽  
Psychoanalytic Treatment ◽  
Risk Benefit Analysis ◽  
Intensive Psychotherapy

Objective: The aim of this paper was to re-examine, via a risk benefit analysis, the rationale of restrictions to long-term intensive psychotherapy and psychoanalytic treatment through the mechanism of the Commonwealth Medicare Benefits Scheme (CMBS) in light of side effects on patients’ access to treatment, their self-esteem, and their privacy. Conclusion: The application of the Global Assessment of Functioning Scale and the specificity of CMBS Item 319 on individual patients’ medical records carry risks that are not offset by demonstrable communal benefits that were predicted when the item was introduced 10 years ago.

scholarly journals Severe and enduring eating disorders: recognition and management

2014 ◽  
Vol 20 (6) ◽  
pp. 392-401 ◽  
Author(s):  
Paul Robinson
Keyword(s):  
Eating Disorders ◽  
Crisis Management ◽  
Learning Objectives ◽  
Psychological State ◽  
Service Development ◽  
List Type ◽  
Type Number ◽  
Specific Group ◽  
Definition Of

SummaryPatients with severe and enduring eating disorders (SEED) may constitute a specific group. It is proposed that patients with anorexia nervosa (SEED-AN) or bulimia nervosa (SEED-BN) that requires the regular attention of a multidisciplinary team and is of a duration known to have a low recovery rate should be included in the SEED group. These patients present with a combination of severe symptoms and long-term illness, and may experience serious chronic physical sequelae (e.g. osteoporosis and renal failure), marked social isolation and stigma. Their carers suffer from the stress of caring for them over a prolonged period. Symptoms, treatment and crisis management of SEED-AN are discussed. SEED is a relatively recently described area of eating disorders psychiatry that requires research and service development so that patients and carers are helped to cope with very serious chronic, but not incurable, conditions.Learning Objectives•Understand the definition of SEED-AN and SEED-BN.•Be able to assess the physical and psychological state of patients with SEED-AN and SEED-BN.•Be able to plan the monitoring and treatment of patients with SEED, involving their carers and families.

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