Agitated State Research Articles

When It's Hard to Please Everybody: Etiquette Serving Ethics When You Disagree With a Colleague

You are a Pain Medicine physician who is asked to see a patient with low back and leg pain in consultation. The orthopedic surgeon requesting the consultation refers a large number of cases to you. He would like you to do two “nerve root blocks,” which will give him confirmation of the “pain generators” and allow him to proceed with a “decompression laminectomy” and most likely a multiple level “posterior fusion,” because of concern about future spinal stability. The patient, a 36-year-old electrician who does not like his present job, has a 5-year history of increasing low back pain, recently exacerbated (according to the patient) by sudden leg pain when carrying a toolbox at work. Although the patient volunteers a whole array of pain complaints, findings from your clinical examination are essentially normal. MRI shows several degenerative disks, which are also bulging at L3-L4 and L4-L5. After trying many medications, the patient is presently not taking any of them (“they don't work” or “I can't tolerate them”). He has spent most of the last two months at home lying down, is on workman's compensation, and is anxious to have surgery as soon as possible “to get rid of the pain.” When you try to tell him that, given your assessment, other treatments may be of benefit to him, he leaves your office in a very agitated state and goes back to the orthopedic surgeon to complain. The surgeon calls to tell you that the patient does not understand “what is going on.” The surgeon is also surprised that the nerve root blocks have not been done, disagrees with you, and is planning to go ahead with surgery. ### Negotiating Uncertainty: “Let's talk …” In his book The Lost Art of Healing , Bernard Lown quotes William Osler's observation that medicine is the “science of uncertainty, and …

Good and Evil Under the Swastika

Those who have survived terror of extermination often feel that all they do is tell story. What they have experienced and suffered remains incomprehensible and impossible to cope with; as Irving Howe says, they can only live with it, in a state of numb agitation.1 Like many others, he finds it foolish to believe that any amount of theoretical analysis help us to ultimately grasp it, and blasphemous to employ their experience for reconstruction of received doctrines, say about nature of evil.2 A few years ago I was invited to participate in a panel on nature of evil, in conjunction with Reclaiming Symbol/The Art of Memory, an Installation by Edith Altman, in State of Illinois Art Gallery. As I understood it, Altman's installation was designed to challenge such pious attitudes and explore ways out of numb agitation and utter powerlessness of victims. As she said in installation-brochure, the swastika loomed in my memory as a fear-producing image of my experience-of my people's experience-of victimization.... I needed to wrestle with it to transform this fear, and to go through dark while never forgetting its lessons.... By taking swastika apart, by deconstructing its meanings and disempowering it, I hoped to change its fearful energy.... My art is a healing ritual through which I want to extract evil from symbol to restore its validity as a positive symbol, to allow it to regain its age old position in culture.4 Her installation has continued to haunt me, and I would like to present in this paper some reasons for challenging immobilizing mystification of suffering and for believing that paying more attention to and analyzing symbols for inflicting it could help us not only to keep alive memory of suffering, but, more importantly, to learn from it something about nature of evil and what we constructively do about it. I begin my argument with question that I feel has been hastily and inadequately answered by many: On what grounds we declare-as we must-the Nazi extermination of millions of innocent people a crime against life? Based on an analysis of symbol of Nazi revolution and ambivalence of good and evil, I argue for a pragmatist response to this question that is fundamentally different from and, I suggest, philosophically more promising than moral answers recommended by Zygmunt Bauman, Irving Howe, Emmanuel Levinas, Hannah Arendt, and others. In dealing with genocide as a pragmatist, I am not interested in appeals to self-evident, but ultimately dogmatic moral intuitions and condemnations, nor in mere memorializing of horrors and numb agitation of victims. Instead, I am preoccupied with experimentally controlled development of effective responses to barbarous acts which have outraged conscience of mankind, i.e., with mobilization of emotions for strategic development of progressive measures and institutional structures on state and global levels to forestall organization of monopolistic agencies of absolute powers For this purpose, I will briefly discuss in this paper use of swastika in organization of Nazi party program in order to learn a lesson from it about what we do to stop such organizations from reaching their goal. The swastika, which in our time has become symbol of evil, has been from time immemorial a sign of life and well-being all over world, including Americas. It has often been-and in parts of world it still is-used for protection against evil. The debate over original meaning of swastika reached its peak in late 1920's after it had been chosen as symbol for Nazi party program for radical renewal and reorganization of social life and engineering of a great society from stock of noble races. At outset, symbol still stood for human well-being, narrowly and strictly re-conceived in terms of racial purity and perfection. …

Military Discipline and Revolutionary Exaltation: The Dismantling of “l’illusion lyrique” in Malraux’s L’Espoir and Bataille’s Le Bleu du ciel

In 1933, Bataille contributed a review of Andre Malraux's novel La Condition humaine to the ultra left-wing journal La Critique sociale. (1) In this article, Bataille questions the place that revolution occupies in the larger and more general context of human He asks, for example, whether the convulsive movements of revolt, social upheaval, and revolution should be situated outside of, or above, what is normally experienced as life in its quotidian expressions of tenderness, enthusiasm or even hate. In the name of what authority, for example, might one be justified in placing the fascination with pleasure, torture and possible death outside the limits of acceptable social practice--extreme states often linked to revolutionary upheaval outside the limits of acceptable social practice? Another way of situating the convulsion of revolutionary movements--an approach clearly endorsed by Bataille--is to place it squarely within the framework of any activity marked by agitation. From this perspective, the acts of torture and murder would arise from an excitability or arousal similar in nature to that intensifying the fury of the revolutionary impulse. This impulse, writes Bataille, is a means by which the proletariat--who had for a long time been deprived of the possibility of attributing any value to suffering and to life--is able to gain access to value itself, a value linked to states of excitation unsubordinated to any simple political means or end. This value, and the state of agitation to which it is linked, gives the proletariat both life and hope, for which even death in all its atrocity might be the payment required: [... ]la Revolution s'identifie dans une convulsion violente avec la valeur et avec le sens de ceux qui la vivent. Car la Revolution est en fait [...] non simple utilite ou moyen, mais valeur liee a des etats desinteresses d'excitation qui permettent de vivre, d'esperer et, au besoin, de mourir atrocement. (CH, 373) Malraux's novel retains Bataille's interest precisely because it does not limit revolutionary activity to the various positive and productive political results to be gained from subversive activity. Rather, Malraux had the insight to allow the orientation of revolutionary activity to be conducted in an atmosphere of death. While Bataille admits that the revolutionary impulse cannot be to this negative orientation, in his view there is generally insufficient recognition of the dominant if limited role played by catastrophe and negation as forces of attraction in the midst of social unrest: Si l'on poursuivait plus avant l'investigation, il apparaitrait meme que catastrophe et negation ont une place dominante (mais limitee) dans l'ensemble de l'experience vecue au cours d'une revolution ... (CH, 374-5) For Bataille, Malraux's La Condition humaine presents un interet exceptionnel not only because it recognizes the way in which revolutionary activity is profoundly linked to the more generalized states of excitability that engender acts of torture, pleasure and death, but because it confronts the revolutionary's attraction to negativity and catastrophe. These values are too often regarded as unfortunate by-products of an agenda that seeks, positively, to redress social injustice, rather than as a dark and desirable impetus at the very heart of the revolutionary impulse. In what follows, I examine the extent to which Malraux subscribes to Bataille's view of social unrest as a force that both ignites and depends on negativity and catastrophe. I determine, as well, the extent to which the fascination with or attraction to death is at odds in Malraux's novel L'Espoir with the positive, constructive political agenda to which the revolutionary is committed. It is against the backdrop of Bataille's Le Bleu du ciel that I examine these issues in L'Espoir, for Bataille's novel, set in Barcelona during the civil war, also depicts the fascination with death and the convulsive agitation common to both revolutionary fervour and sexual agitation. …

Induction of manic symptoms by novel antipsychotics

There have been scattered reports of mild states of agitation induced by novel antipsychotic agents, in particular disturbed affect during a switch study of risperidone ([Ashleigh & Larsen, 1998][1]) and doubtless other cases which have never been reported. At least 19 cases have been reported of

Negative-ion implanter for powders and its application to nanometer-sized metal particle formation in the surface of glass beads

We have developed a negative-ion implanter for uniform implantation into each powder surface without particle scattering. It consists of a plasma sputter-type negative-ion source, a mass separator, an acceleration tube, a lens, X–Y deflectors, a 90° deflector, and a Faraday cup with an agitator. The electrostatic 90° deflector bends a horizontal beam to a vertical direction and leads it into the Faraday cup. The agitator is an electromagnetic vibrator at a frequency of 120 Hz, which mixes particles for whole surface treatment and uniform implantation. In this implanter, we obtained no scattering implantation for spherical oxide beads with diameters ranging from 5 to 1000 μm in an agitated state, and also obtained a good uniformity of implanted atoms among beads. For an application of the negative ion implantation into powders, copper ions were implanted into soda-lime glass beads and plates at conditions of 50 and 30 keV, respectively, with 1×1017 ions/cm2. In linear optical properties, both implanted samples show a clear absorption at a photon energy of 2.2 eV due to resonance absorption of copper surface plasmon. In addition, the implanted glass plate shows the large third-order nonlinear susceptibility, χ(3)=1.3×10−7 esu. These results suggest the existence of copper nanometer-sized particles in glass.

Life-threatening brain failure and agitation in the intensive care unit

The modern intensive care unit (ICU) has evolved into an area where mortality and morbidity can be reduced by identification of unexpected hemodynamic and ventilatory decompensations before long-term problems result. Because intensive care physicians are caring for an increasingly heterogeneous population of patients, the indications for aggressive monitoring and close titration of care have expanded. Agitated patients are proving difficult to deal with in nonmonitored environments because of the unpredictable consequences of the agitated state on organ systems. The severe agitation state that is associated with ethanol withdrawal and delirium tremens (DT) is examined as a model for evaluating the efficacy of the ICU environment to ensure consistent stabilization of potentially life-threatening agitation and delirium.

Toxicological analysis in agitated patients.

To assess the toxicological etiologies in agitated patients and to evaluate their initial clinical diagnosis in the light of toxicological results analysis. Prospective clinical study. Emergency Department (ED) in a 2,650-bed University Hospital. Fifty-eight consecutively enrolled patients admitted to the ED in agitated states over a 6-month period. All patients underwent laboratory tests including blood glucose, ethanol and serum drug screening. Toxicology tests were conducted by fluorescence polarization immunoassay and confirmed by high performance liquid chromatography/diode array detector and gas chromatography-mass spectrometry. The physician's initial diagnosis was evaluated in the light of toxicological analysis results. Serum toxicological analysis revealed that 50/58 patients were under the influence of alcohol and/or a drug. Benzodiazepines (22/58), selective serotonin reuptake inhibitors (5/58) and opiates (4/58) were the most frequently observed. The initial clinical diagnosis was alcohol intoxication in 39 patients, although 1 patient was not under the influence of alcohol and 16 also had benzodiazepine in their sera. Moreover, the diagnosis of serotonin syndrome was overlooked in two patients. Most agitated patients were under the influence of alcohol and/or a drug. Benzodiazepine alone or in association with alcohol was surprisingly frequent. A serotonin syndrome may explain the agitation state.

Agitation in the ICU: part one Anatomical and physiologic basis for the agitated state

The term 'agitation' describes a syndrome of excessive motor activity, usually nonpurposeful and associated with internal tension. For intensivists, agitation is not so much a diagnosis, but a consequence of more fundamental etiologies that, when expressed, result in disquietude. Agitation is important in the intensive care unit (ICU) because it can alter the diagnosis and course of medical treatment. It can cloud the etiology of underlying disease processes like a smoke screen, making effective diagnosis difficult or impossible. It may result in the inability of the patient to cooperate with monitoring and therapeutics that requires them to lie relatively still and quiet. Treatment of agitation without considering underlying causation gives the false impression of wellness when in reality end-organ damage is occurring either as a result of agitation itself, or as a result of exacerbation of underlying pathology. Prior to the technological revolution in critical care medicine, agitation was a relatively minor issue. Little could be done for critically ill patients but make them as comfortable as possible and observe them for treatable decompensations. Modern ICUs now have the potential to return critically ill patients to productivity using technological advances in monitoring and closely titrated care, effectively pinning the patient firmly to the bed with tubes and appliances. As a result of our high-tech hemodynamic monitoring and support devices, we have conferred upon the already hemodynamically unstable patient new kinds of stress we never had to deal with before, and simplistic, symptomatic 'shotgun' sedation no longer applies.

A Speculum in the Text: Freud's "Katharina" and Maupassant's "Le Signe"

Early one morning, the Marquise de Rennedon is awakened by her friend, the Baronne de Grangerie, who is in a state of great agitation and needs to confide in her. Sitting at her window overlooking the rue Saint-Lazare the previous afternoon (explains the Baronne), she had noticed another woman at an open window on the other side of the street, a woman in red she decides must be a vilaine fille. This woman is in fact plying her trade and the young Baronne is quickly fascinated by the ease with which she makes contact with prospective clients in the street below. Yet there seems to be no overt communica-

Hemiparesis and Altered Mental Status in a Child After Glyburide Ingestion

A normally healthy 6-year-old woke in an agitated state, limp, and moving only her left extremities. Upon arrival at the emergency department, a blood glucose measurement was 34 mg/dL. The child was lethargic, not responding to questions appropriately, and not moving her right extremities. The right arm was flexed, and the right leg was flexed and abducted. Pupils were equal and reactive, and eyes were deviated to the left. Six loose tablets of the grandmother’s glyburide were found at home in the child’s outdoor playhouse. Administration of glucose produced no change in the child’s clinical condition. Intravenous glucose was begun at 4 mg glucose/kg/min, and the blood glucose level did not fall below 74 mg/dL after that. Over the next 48 h, the hemiparesis and mental status changes resolved without sequelae. The events of the case suggest a hypoglycemia-induced seizure with subsequent Todd’s paralysis. Early direct medical evaluation in suspected glyburide ingestions in children is suggested.

Relationship between behaviour and heart rate as an indicator of stress in domestic sheep under different housing systems

Four adult Bergamasca rams were used in three types of housing: (1) common enclosures, consisting of a wooden paddock of 3 m × 7 m, partially covered by a shed; (2) metabolic cages of 57 cm × 135 cm; (3) fixed housing, with the animals tied by a rope about l m in length to a ring fixed on a wall. Heart rate was measured by means of a biotelemetric system during free standing, free lying, restrained standing and restrained lying, feeding, mastication, ruminating and drinking. The results show that rams, housing system and the interaction between behaviour and housing system affected heart rate ( P < 0.001) during restrained standing and restrained lying. Heart rate in metabolic cages was lower ( P < 0.001) than in other housing systems. Behaviour (considering only restrained standing and restrained lying) did not affect heart rate. Nevertheless, the interaction between behaviour and housing system showed that, within each housing system, heart rate during restrained standing was always higher than during restrained lying ( P < 0.001). In all types of housing systems, a higher heart rate was observed in the second measurement ( P < 0.001), which implies a state of greater agitation in the animals, probably due to the absence of a constant and familiar figure in the present experiment. From a methodological point of view, this study underlines the importance and efficacy of the determination of heart rate as an indicator of the reactive state of sheep.

Predictive factors of early seizures after acute cerebrovascular disease.

Seizures within the first 48 hours of a first stroke or transient ischemic attack (TIA) are an independent prognostic factor for in-hospital mortality. The aim of this study was to determine predictive factors of early seizures in first-ever stroke patients. Data of 1220 first-ever stroke patients admitted consecutively to an acute stroke unit of a 450-bed teaching hospital between January 1986 and December 1993 were collected from a stroke registry. Demographic, anamnestic, clinical, neurological, and neuroimaging variables in the seizure and nonseizure group were compared using the t test and the chi 2 test. The independent predictive value of each variable on the development of early seizures was assessed with a logistic regression analysis. Early epileptic seizures were diagnosed in 29 patients (2.4%). Seizures were significantly more frequent in patients with hemorrhagic stroke (4.3%) than in those with ischemic stroke (2%). Patients with seizures were significantly younger and significantly more likely to have acute confusional state, cortical involvement, large stroke, and involvement of the parietal, frontal, occipital, and temporal lobes than patients without seizures. The in-hospital mortality rate was 37.9% in the seizure group and 14.4% in the nonseizure group (P < .0005). After multivariate analysis, only cortical involvement (odds ratio of 6.01) and acute agitated confusional state (odds ratio of 4.44) were independent clinical factors for developing epileptic seizures. Cortical involvement in the neuroimaging studies and agitated acute confusional state at the onset of stroke were independent predictive factors of early seizures in first-ever stroke patients. The efficacy of anticonvulsant drugs in the prophylactic control of seizures should be assessed in prospective, randomized, double-blind clinical trials conducted in the subgroup of patients with the highest risk of developing epileptic seizures.

Clinical subtypes of bipolar mixed states:: Validating a broader European definition in 143 cases

Objective: To validate and clinically characterize mixed bipolar states derived from the concepts of Kraepelin and the Vienna School and defined as sustained instability of affective manifestations of opposite polarity — that usually fluctuate independently of one another — in the setting of marked emotional perplexity. Method: Our criteria for mixed states represent a modified “user-friendly” operationalization of these classical concepts. We compared 143 mixed state patients, so defined, with 118 DSM III-R manic patients, systematically evaluated with the Semistructured Interview for Depression (SID) in our in-patient and day-hospital facilities. Results: The two groups were comparable from demographic and familial standpoints (including family history for bipolar disorder). Mixed states were predominant in the past history of index mixed patients who were more likely to have experienced stressors and to have attempted suicide; manic and hypomanic episodes were more common in the past history of the index manic patients who, in addition, had more episodes and hospitalizations. Although rates of chronicity and rapid cycling were not significantly different in the two groups, the modal episodes in the mixed states were 3–6 months, and in mania they were less than 3 months. Two thirds of both groups arose from a dysregulated baseline temperamental dysregulation, which, in manics, was largely hyperthymic, and in mixed patients, was both hyperthymic and depressive. Of our 143 mixed states, only 54% met the DSM III-R criteria for mixed states (which conformed to “dysphoric mixed mania”); of the remaining, 17.5% could be described as “mixed agitated psychotic depressive states” with irritable mood and flight of ideas, and 26% as “unproductive–inhibited manic” with fatigue and indecisiveness. The family history and course of these “non-DSM III-R” mixed states were essentially similar to DSM III-R mixed states. Limitation: Family history could not be obtained blind to clinical status in patients with severe psychotic mood states. Clinical Relevance: These data favor the classical European approach to mixed states over the grossly under-inclusive current official diagnostic systems. Conclusion: The phenomenology of mixed states is more than the mere superposition of opposite affective symptoms and, in many instances, it represents an expansive–excited phase intruding into a depressive temperament, and a melancholic episode intruding into a hyperthymic temperament.

Particle-Size Analysis of Soils Using Laser Light Scattering and X-Ray Absorption Technology

Abstract The particle-size distribution for the fine-grained fraction of eleven soil samples was determined using four commercially available, state-of-the-art automated particle-size distribution analysis instruments. Two of the instruments operate on the principle of interaction of laser light with soil particles suspended in water in a highly agitated state, and two operate on the principle of the absorption of an X-ray beam by a suspension of soil particles settling in a quiescent column of water. The results from each instrument for each soil sample were compared to size analysis data determined by the hydrometer technique. The X-ray absorption instruments produced particle-size distributions very close to those of the hydrometer method, with the exception of soils with high mica concentrations. The laser-based instrument data did not agree as well with the hydrometer data, although for soils with significant mica contents the results were closer than the results from the X-ray absorption instruments. Based on these results, however, it appears that the automated X-ray absorption/sedimentation-based instruments show promise as alternatives or as a possible supplement for the manual hydrometer method of size analysis for soils without significant mica particle concentrations.

Traumatic transection of the intrapancreatic common bile duct due to blunt injury: a case report and literature review

An N-year-old previously healthy man was brought by the Emergency Medical Team to our hospital, an hour after being beaten up by a gang of young men. He had been beaten all over his body including several blows to his abdomen. He was conscious (Glasgow Coma Scale 13), although agitated. Vital signs were, heart rate 116 beats/ min and BP 110/‘70 mmHg. His only complaint was of diffuse abdominal pain. On physical examination, ecchymoses and contusions were absent, no penetrating wounds were present and a small laceration of 3 cm on the lower lip was noted. Lung examination was normal. The abdomen was flat with diffuse tenderness in all four quadrants. There were no other abnormalities. Because of his intoxicated and agitated state the patient was sedated and anaesthetized and an elective intubation was performed. At this point a nasogastric tube was inserted and brought up 300 cm3 of coffee-ground material. A urinary catheter was inserted with good urine output and no signs of haematuria. X-Rays of the chest, pelvis and cervical spine were normal. Computed tomography (CT) of the head revealed findings of a small frontal intracerebral bleed. There were no signs of increased intracranial pressure (Figure 2). CT of the abdomen showed free fluid in the abdominal cavity extending from the subhepatic region to the pelvis. The spleen and liver were intact (Figure 2). Because of the intact spleen and liver and the presence of free fluid in the abdomen, the abdomen was explored. A large subcutaneous haematoma was observed in the epigastric regtion, and 500 cm3 of fresh blood was aspirated from the peritoneal cavity. A large haematoma was detected in the retroperitoneum extending from the duodenum down to the sacral region. A blotch of bile was found staining the upper portion of the first part of the duodenum. A Cattell procedure was performed and the duodenum was mobilized using the Kocher manoeuvre, at which time a blowhole of 2 mm by 3 mm was observed in the duodenum, approximately in the middle of the 1st to 2nd division of the organ. Exploration of the common bile duct showed an intact duct. During the procedure bile was noticed to exude from

Acute confusional migraine and trauma-triggered migraine

Migraine in children can present as a state of confusion or agitation with or without a history of migraine. These events can arise spontaneously or can be triggered by mild head trauma. Transient blindness and hemiplegia may accompany the confusional state. We present two cases of children with histories of confusion and agitation, one with multiple episodes after mild head trauma. The symptomatology, differential diagnosis, theories on pathogenesis, and natural history of confusional migraine are discussed.

Propofol in terminal care

In advanced cancer patients close to death, delirium, multifocal myoclonus, and restlessness may occur. Multi-organ failure and related metabolic changes are mostly responsible for these symptoms. A pharmacologic approach to manage the delirium is necessary in the majority of cases. Benzodiazepines, neuroleptics, and barbiturates are the most common drugs used. In the case reported, propofol administered at very low doses provided good control of neuropsychiatric symptoms. After a loading dose of 20 mg, an infusion of 50–70 mg per hr was started. The patient died peacefully after 8 hr of propofol infusion, without requiring opioids. Propofol seems to be a promising drug in treating the terminal agitated state that can be associated with the dying process.

Touch-evoked Agitation Produced by Spinally Administered Phospholipid Emulsion and Liposomes in Rats

Phospholipid-based liposomes can alter the kinetics of spinally administered agents. We have observed that spinal delivery of these preparations results in an unexpected touch-evoked agitation, a state in which light touch evokes vocalization by the rat. In the current study we characterized this agitated state induced by various liposome preparations. Rats prepared with lumbar intrathecal catheters received a variety of phospholipids delivered spinally as emulsions or as liposomes. Before and after injection, the animal's hot-plate latency (52.5 degrees C surface), spontaneous mobility, and spontaneous and evoked pain behavior were assessed. Spinal delivery of L-alpha-phosphatidylcholine of egg yolk (L-EPC) and the phospholipase hydrolysis product (lyso-L-alpha-phosphatidylcholine [lyso-L-EPC]) produced dose-dependent touch-evoked agitation; the order of potency and rapidity of onset was lyso-L-EPC > L-EPC, with no difference in activity whether administered as an emulsion or as a liposome preparation. Examination of the activity of a series of pure phospholipids revealed the ordering of touch-evoked agitation potency (where PC = phosphatidylcholine) to be L-monopalmitoyl-PC (lyso product of L-dipalmitoyl-PC) > L-dipalmitoyl-PC > L-distearoyl-PC, L-dioleoyl-PC >> L-dilauroyl-PC > L-dimyristoyl-PC; D-dipalmitoyl-PC = 0. The effect of unsaturation on touch-evoked agitation cannot be predicted because dioleoyl-PC and dioleoyl phosphatidylglycerol produced touch-evoked agitation but dipalmitoleoyl-PC did not. Substitution of glycerol for choline as the head group had no influence on touch-evoked agitation. Spinal treatment with an inhibitor of phospholipase (mepacrine) or a cyclooxygenase (ketorolac) blocked the touch-evoked agitation of L-EPC but not that of lyso-L-EPC. These results emphasize that certain L-isomeric phospholipids with their gel-transition temperatures near body temperature can produce prominent touch-evoked agitation after spinal delivery, an effect likely mediated by a phospholipase hydrolysis product. This touch-evoked agitation, which is consistent with neurotoxicity reported in the early literature on lysophospholipids, suggests that the choice of lipids for the formulation of liposomes intended for spinal drug delivery should be carefully considered.

Divalproex Sodium as a Treatment for Borderline Personality Disorder

Divalproex sodium was given to a series of individuals with the diagnosis of borderline personality disorder. Objective measures of agitation and anxiety were then used to assess the effect of divalproex sodium on such symptoms. Data were collected on the subjects and the amount of time spent in the agitated state was evaluated. We found that divalproex sodium reduced agitation in our subjects.

Sudden death, neuroleptics and psychotic agitation

1. 1. The concept of “neuroleptic death” as a phenomenologically valid entity is still in controversy. The present paper describes 13 cases of sudden, unexpected and unexplained deaths among psychiatric inpatients that might be attribute to neuroleptic treatment. 2. 2. This number represents 7% of the death in three regional psychiatric institutions, during the last decade. All of them manifest a uniform clinical profile: young schizophrenic patients, healthy otherwise, whose post mortem examination failed to reveal the cause of death. Shortly prior to death, all of them suffered from a state of extreme psychotic agitation which did not respond to high dose regime of neuroleptic drugs. 3. 3. The authors suggest that this, common clinical pattern, typical of those patients, which ends by sudden death, is due to sudden neuroleptic death. The authors recommend that in cases of treating resistant pychotic exacerbation, one should seriously consider the risk when increasing doses of neuroleptics or using unusual combinations of these drugs.