Long-acting Neuroleptics Research Articles

Auto-stigmatisation et fonctionnement dans le trouble bipolaire

Self-stigma of people with bipolar disorder is an underestimated problem, with serious consequences in terms of clinical severity and social and professional functioning. ObjectivesThis study aimed to evaluate self-stigma in patients with bipolar disorder, to identify socio-demographic and clinical factors associated with it and to analyze the links between self-stigma and functioning in this population. MethodsWe conducted a cross-sectional, descriptive and analytic study including 61 patients with bipolar disorder meeting criteria of remission. We used the internalized stigma of mental illness (ISMI) to investigate self-stigma, and the functioning assessment short test (FAST) to assess functioning. ResultsThe mean age of patients was 43.4 years. The sex ratio was 2.4. Half of the patients were single or divorced (50 %). They had secondary or university education in 69 % of cases and were professionally inactive in 59 % of cases. The socioeconomic level was low or medium in 92 % of cases. A personal judicial record was found in 16 % of patients, a suicide attempt in 41 % of cases. Most patients in our series had bipolar I disorder (92 %). The mean age at onset of the disease was 23.5 years, with a mean duration of disease progression of 20 years. Patients were hospitalized an average of 5.9 times. Most patients (90 %) exhibited psychotic features during their mood relapses. The mean duration of the last remission was 27.9 months. Patients had regular follow-ups at our consultations in 87 % of cases. Among the patients included in the study, 8 % were on long-acting neuroleptics. The mean score on the internalized stigma of mental illness was 2.36±0.56. More than half of our patients (59 %) were self-stigmatized. Discrimination and alienation were found in 51 % of cases, followed by resistance to stigmatization (43 %) and assimilation of stereotypes (41 %). Regarding functioning, a global impairment was noted in more than two thirds of patients (71 %). An alteration in professional functioning was found in 82 % of cases and in cognitive functioning in 69 % of cases. Disruption of the financial sphere concerned 43 % of the patients, and the relational sphere 41 % of them. Autonomy was altered in 41 % of patients. Analysis of the relationships between self-stigma and characteristics of the study population revealed statistically significant associations between higher self-stigma scores and single or divorced status, low socio-economic level and judicial record. In terms of clinical parameters, the mean self-stigma score was significantly associated with a higher total number of thymic episodes and hospitalizations, a longer cumulative duration of hospitalizations and a shorter duration of the last remission. In addition, the mean self-stigma score was associated with significantly more impaired functioning. ConclusionsOur study underlines the need to work towards the implementation of management modalities aimed at combating the self-stigmatization of patients with bipolar disorder and mitigating its negative consequences during the course of the disease.

Myasthenia and bipolar disorder: a case report and review of literature

IntroductionThe association between somatic diseases and bipolar disorder (BD) have been described especially for auto-immune diseases.ObjectivesThrough a case study and a review of literature we are going to describe a comorbidity of BD and myasthenia.MethodsStarting from a case report, we conducted a literature review on “PubMed”, using a key word “myasthenia and bipolar disorder”ResultsThe patient AJ, 57 years old, married, mother of 5 children; 4 sons and 1 daughter who also has BD. She is illiterate and a full-time mother. she has high blood pressure, a congestive gastropathy and hemorrhoids. She has been diagnosed with BD in 1987 (at 21 years old) and mainly had depressive episodes. She was put on Amitriptyline, carbamazepine, long-acting neuroleptics and benzodiazepines. Since 2006 the patient has been reporting persisting myasthenia even when she was euthymic. In 2009, she was hospitalized for persistent headaches, pain and a decrease in visual acuity in the right eye. An ophthalmoscopy, a cranial CT-scan and an MRI were performed with no anomalies. Then a fluctuant ptosis and an intense fatigability appeared. She then was hospitalized in a neurology ward where she was diagnosed with myasthenia. Changes in her treatment had to be made. Carbamazepine was switched to valproic acid, amitriptyline was switched to fluoxetine. And benzodiazepines were stopped.ConclusionsIt’s important to pay close attention to somatic diseases in our patients in order to insure appropriate medical care. Also, the association between somatic disorders and BD can be an interesting lead in elucidating the etiopathogeneses of BD.DisclosureNo significant relationships.

2073 – Retinopathy induced by zuclopentixol depot: A case report

Neuroleptics constitute an heterogeneus group of drugs used to treat mental illness. As known, long-acting depot neuroleptics receive increasing consideration in the maintenance treatment of individuals diagnosed of schizophrenia with low insight or poor treatment adherence. Zuclopentixol depot is a typical antipsychotic agent. It operates through a mechanism of extended release. It is characterized by antagonizing Dopamine receptors, particulary D2. It also works on alfa1 adrenergic and serotonine 2A receptors. Its effect on histamine H1 receptors is weak, and presents no affinity with cholinergic receptors. The literature reports ocular disorders due to treatment with neuroleptics. Typical antipsychotic can induce degenerative retinopathy which histologically and clinically simillar to primary pigmentary retinitis. Nevertheless, after showing initial interest, clinicians and researches no longer paid enough attention to them. Most of the cases reported are related to Phenotiazine antipsychotic family. Phenotiazines bind to melanin granules and can cause a severe phototoxic retinpathy. We have not found retinal disorders caused by Zuclopentixol in the literature reviewed. Pathogenis involved in retinopathia induced by neuroleptics is still unknown. Neuroleptics operate through a mechanism based on the antagonism of dopaminergic receptors. This blockade may influence the genesis of retinopathy. Several hypothesis emphasized in how neuroleptics, by antagonizing dopaminergic receptors, can influence melanine absortion in the uveal track and choroid. This is the reason why there could be a relation between antidopaminergic mechanism and choroid through the vascular supply.

233 EFFECTS OF A LONG-ACTING TRANQUILIZER ON SPERM MOTILITY OF NORTH AMERICAN BISON BULLS

Handling induces stress in North American bison that can lead to injuries for both handlers and animals. Moreover, this induced stress may result in variations in collection and quality of the semen. The objective of this study was to investigate if a long-acting neuroleptic (LAN) can lower the stress on bison bulls, allowing for safer handling and improvement in the quantity and quality of the collected semen. For this study, 6 mature bison bulls (3 Bison bison bison and 3 Bison bison athabascae) housed at the Native Hoofstock Centre, near Saskatoon, SK, Canada, were used. For each trial, bison bulls were randomly separated into 2 groups: LAN-treated (n = 3) and nontreated control (n = 3). In the treatment group, each bull was injected with 100 mg of Piportil L4® (piperodine phenothiazine, a LAN with antipsychotic properties and weak sedative activity that has a prolonged duration of action ≈2 wk). After injection, both groups were given a 5-day rest period before semen collection. All bison were collected by electroejaculation, twice a week for 2 wk with a minimum 48 h of rest between collections (total of 3 trials; 4 collections per trial). Between each trial, a rest period of 1 wk was given to the bulls. To evaluate the stress level of the animal, the bull’s heart and respiration rates were recorded before and after each collection. Electroejaculated semen was kept at 37°C and transported to the laboratory for further semen analysis (≈2 h). Semen was analysed using computer assisted sperm analyzer. Several parameters including volume, concentration, total motility, progressive motility, velocity curvilinear (VCL), velocity average path (VAP), and velocity straight line (VSL) were recorded. The data were analysed using two-way ANOVA (SAS 9.2; SAS Institute, inc., Cary, NC, USA). Data are presented as mean ± SD and P < 0.05 level of significance. Results for the stress level revealed that the heart rate (beats/min) before semen collection (control: 65.8 ± 14.6, treated: 65.3 ± 9.4) and heart rate after semen collection (control: 67. 9 ± 14.4, treated: 62.9 ± 9.1) showed no differences between control and treatment. Both respiration rates (breaths/min) before and after collection did not show difference due to treatment (control: 44.1 ± 17.5 and 36.6 ± 15.1, and treated: 41.6 ± 22.0 and 35.3 ± 14.3, respectively). Results of the semen analysis showed no significant effect of treatment on the volume of ejaculate between control (5.3 ± 2.0 mL) and treated (4.6 ± 2.4 mL). Both total and progressive motility of the semen showed no difference between control (70.5 ± 18.1% and 64.6 ± 19.4%) and treated (64.6 ± 22.7% and 58.6 ± 23.2%), respectively. No significant effects were seen in any of the sperm velocity parameters (μm s–1): VCL, 123.5 ± 31.5 in control and 121.7 ± 28.9 in treated; VAP, 75.4 ± 18.7 in control and 71.8 ± 17.2 in treated; and VSL, 62.3 ± 16.9 in control, and 59.3 ± 15.3 in treated groups. It can be concluded that 100 mg of Piportil has no discernible effect on stress levels, sperm count, or motility in bison bulls. Funded by Agriculture Development Fund (#2008044) and Canadian Animal Genetic Resources program.

Use of a neuroleptic in assisted reproduction of the critically endangered Mohor gazelle ( Gazella dama mhorr)

Stress is a limiting factor in assisted reproduction in wild animals maintained in captivity and measures to reduce it should improve reproductive success. The effect of the long-acting neuroleptic (LAN) perphenazine enanthate was assessed on ovarian stimulation for the recovery of immature oocytes from Mohor gazelle ( Gazella dama mhorr) and their subsequent in vitro maturation, fertilization and embryo culture. The viability of embryos after transfer was also examined. Perphenazine enanthate decreased activity levels and facilitated handling of treated animals when compared to controls. LAN-treated animals showed a more regular pattern of respiratory and heart rates and body temperature than controls; no major differences were found in hematological and biochemical parameters between groups. Perphenazine-treated females had lower plasma cortisol levels during the days of intense handling. No significant differences were found in the number of punctured follicles and recovered oocytes between groups. The percentage of mature oocytes per female was significantly higher in the LAN-group. Fertilization and cleavage rates were not significantly different between groups. Embryos developed in culture but none reached the blastocyst stage, and those transferred to the oviduct of synchronized recipients did not develop to term. In conclusion, treatment of females with perphenazine enanthate during ovarian stimulation did not have negative effects on maturation, fertilization and embryo development in vitro. Moreover, an increase in oocyte maturation rate per female was observed. Thus, the use of LANs could be useful to alleviate the effects of handling-stress during assisted reproductive procedures in wild ungulates.

Antipsychotic treatment and the need for hospitalization: advantages of long-acting neuroleptics

Antipsychotic treatment and the need for hospitalization: advantages of long-acting neuroleptics

Long-acting neuroleptics used in wildlife management do not impair thermoregulation or physical activity in goats (Capra hircus)

Long-acting neuroleptics commonly are used in wildlife management to decrease stress-related mortality in wild animals, but with possible effects on thermoregulation, which may contribute to residual morbidity and mortality. We investigated the effects of haloperidol (0.01, 0.1, 1 mg kg(-1), n=4), zuclopenthixol (0.1, 1, 10 mg kg(-1), n=4) and perphenazine (0.1, 1, 10 mg kg(-1), n=8), as well as control injections of sunflower oil, on body temperature and physical activity of laboratory goats under hot, cold and thermoneutral ambient temperatures. Implanted data loggers continuously recorded abdominal temperature, and data loggers attached externally on the foreleg recorded movement of unrestrained goats, in a climatic chamber at 35 degrees C, 10 degrees C and 22 degrees C. Cycling ambient temperature between 35 degrees C in daytime and 10 degrees C at night time caused a significant increase in amplitude of the circadian rhythm of body temperature in goats given sunflower oil (P=0.0012, unpaired t-test, n=8), but the administration of zuclopenthixol or perphenazine did not affect this change in amplitude (P>0.05, two-way ANOVA, n=4). Mean daily body temperature after administration of zuclopenthixol or perphenazine, and mean daily activity after zuclopenthixol administration, were not significantly different to those after control injections, at any ambient temperature, for the expected duration of drug activity (all P>0.05, two-way ANOVA, n=4). Thermal response indices, and mean activity, during heat, cold or thermoneutral exposure, of goats for 7 h after haloperidol injection, were not significantly different, at any dose or any ambient temperature, to those following control injections (all P>0.05, repeated measures ANOVA, n=4). Long-acting neuroleptics did not impair activity or thermoregulation of goats subjected to inescapable thermal challenges.

Thermoregulatory, motor, behavioural, and nociceptive responses of rats to 3 long-acting neuroleptics

We investigated physiological effects of intramuscular injections of the following 3 long-acting neuroleptics commonly used in wildlife management: haloperidol (0.05, 0.1, and 0.5 mg/kg body mass), zuclopenthixol acetate (0.5, 1, and 5 mg/kg), and perphenazine enanthate (1, 3, and 10 mg/kg), in a rat model. Body temperature and cage activity were measured by intra-abdominal telemeters. Nociceptive responses were assessed by challenges to noxious heat and pressure. Haloperidol (0.5 mg/kg) produced a significant nocturnal hypothermia (p < 0.05) and decreased nighttime cage activity and food intake. Zuclopenthixol (5 mg/kg) significantly decreased nighttime body temperature and cage activity and, at 1 mg/kg and 5 mg/kg, significantly decreased food intake 5-17 h after injection (p < 0.05). Perphenazine (10 mg/kg) significantly decreased nighttime body temperature and cage activity and, at all doses, significantly decreased food intake 5-17 h after injection (p < 0.05). Significant analgesic activity was evident in rats given 5 mg/kg zuclopenthixol up to 40 h after injection, and 10 mg/kg perphenazine from 48 to 96 h after injection (p < 0.0001). Zuclopenthixol (5 mg/kg) and perphenazine (10 mg/kg) had significant antihyperalgesic activities at 16 h postinjection and 24-48 h postinjection, respectively (p < 0.0001). Haloperidol had no significant antinociceptive activity at doses tested. Motor function was impaired in rats given 0.5 mg/kg haloperidol, 5 mg/kg zuclopenthixol and 10 mg/kg perphenazine. Effects of long-acting neuroleptics on body temperature, feeding, and activity were short-lasted and should not preclude their use in wildlife. Antinociceptive actions were longer-lasting, but were nonspecific, and we recommend additional analgesics for painful procedures during wildlife management.

Stress in wild-caught Eurasian otters (Lutra lutra): effects of a long-acting neuroleptic and time in captivity

AbstractAs part of a translocation project, 28 Eurasian otters (Lutra lutra) were captured from the wild and transported to the Barcelona Zoo for veterinary evaluation, quarantine and intraperitoneal implantation of telemetry devices. Eleven animals were injected with the long-acting neuroleptic (LAN) perphenazine enanthate at the time of capture and the remaining animals served as a control group. During their time in captivity, which averaged 23 days, all of the animals were bled three times. Haematological and biochemical parameters were evaluated, including red blood cell count (RBC), haemoglobin (Hb), white blood cell count (WBC), blood urea, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (AP), lactate dehydrogenase (LDH), creatine kinase (CK), albumin, and serum cortisol. No significant differences were found between treated and control otters except for monocyte count, which was higher in treated animals. Time after capture had an effect on many parameters. RBC and Hb decreased at first and then increased, while WBC and segmented neutrophils decreased over time. Most of the biochemical parameters considered to vary in relation to stress, including AST, ALT, CK, AP and LDH, decreased over time, suggesting that the stress responses of the animals decreased throughout the period of captivity. However, no significant change in serum cortisol levels was noted. The lack of effect of perphenazine treatment on haematological parameters should encourage further research on other stress indicators applicable to wild animals, such as behaviour or faecal cortisol concentration. Finally, the results obtained in this study suggest that, when captive conditions are adequate, keeping wild-caught animals in human care for a period of time prior to their release into the wild can be beneficial. However, further studies taking into account other welfare indicators would be useful.

P.2.005 Long-acting neuroleptics in preventing relapse and rehospitalization among schizophrenic patients

P.2.005 Long-acting neuroleptics in preventing relapse and rehospitalization among schizophrenic patients

P.2.011 - Long-acting neuroleptics treatment of patients in residential rehabilitation programs

P.2.011 - Long-acting neuroleptics treatment of patients in residential rehabilitation programs

Use of long-acting neuroleptics to reduce the stress response to management practices in red deer

Three groups of six adult red deer hinds were used to determine whether long-acting neuroleptic (LAN) tranquillisers were able to modify the behavioural and physiological responses of the deer to a range of routine management stressors: such drugs may eventually prove useful in capture procedures for wild animals. While the stressors increased moving activity and decreased inactive lying and inter-animal distances, these changes were reduced in LAN-treated animals. Blood samples, collected remotely using automatic equipment, showed that following application of the stressors there was a distinct rise in plasma cortisol concentrations which returned to pre-treatment levels more rapidly in LAN-treated animals. However, there was no effect of LAN treatment on plasma concentrations of creatine phosphokinase (CPK), aspartate aminotransferase (AST), total protein or testosterone. Overall, LAN-treated animals had higher concentrations of plasma thyroxine. Heart rate increased in response to the stressors and while the LAN-treated deer showed a greater increase, as with plasma cortisol concentrations, heart rate returned to baseline more rapidly in these animals. We conclude that LANs may have a role to play in wild deer capture and habituation to farming conditions through a reduction in fear and anxiety, but that further work is required to determine an optimal strategy.

Reappraisal of Lytic Cocktail/Demerol, Phenergan, and Thorazine (DPT) for the Sedation of Children

We were disappointed in the AAP statement by the Committee on Drugs entitled Reappraisal of Lytic Cocktail/Demerol, phenergan, and Thorazine (DPT) for the Sedation of Children (Pediatrics 1995;95:598-602). The Committee identified many problems associated with this traditional drug mixture but refused to bite the bullet and acknowledge that its time is past. Their unqualified endorsement of ketamine and propofol use by nonanesthesiologists also concerns us. The lytic cocktail contains a long-acting opiate with a tendency to activate seizures and two long-acting neuroleptics.

Physiological responses of farmed red deer to management practices and their modulation by long-acting neuroleptics

SUMMARYTwelve red deer (Cervus elaphus) hinds from a research facility in Eastern Scotland were randomly divided into two groups between June and September to study the physiological response to three management practices, given sequentially, which were expected to cause increasing levels of stress (herding; herding and handling; and herding, handling and a veterinary procedure). One group of animals received a long-acting neuroleptic (LAN; perphenazine enanthate and zuclopenthixol acetate) on three occasions at 4-week intervals. Automatic blood sampling equipment (ABSE) was used to obtain blood samples remotely before, during and after the application of each of the stressors. The plasma concentrations of cortisol, creatine phosphokinase (CPK), aspartate aminotransferase (AST), total protein (TP), 3,5,3'-triiodothyronine (T3), thyroxine (T4) and testosterone (T) were measured and heart rates recorded. The ABSE provided a useful means of collecting blood samples without the superimposition of stress factors associated with conventional sampling. Increases in plasma concentrations of cortisol (P&lt;0·01), CPK (P&lt;0·01) and AST (P&lt;0·05) were observed in all animals in response to all three management practices. There were smaller increases in plasma cortisol concentration (P&lt;0·05) in those animals treated with LAN. The results suggested a degree of habituation of the hinds to some procedures common to all treatments, in agreement with previous analysis of the behavioual response of these animals. Peaks of heart rate were recorded over the 30-min period stressors were applied. Higher heart rates and T3 and T4 concentrations were observed in LAN-treated animals. Heart rates returned to baseline more rapidly in the LAN-treated animals. Higher plasma concentrations of testosterone were recorded in the first week of the study (P&lt;0·001). Physiological and behavioural evidence supports the view that LANs are effective long-term tranquillizers in red deer.

Depot Neuroleptics: Cost-effective and Underutilized

To the Editor. —Direct treatment costs of schizophrenia in the United States total more than $10 billion per year. 1 Approximately 50% of patients with chronic schizophrenia receiving outpatient treatment relapse within 1 year after discharge as a result of medication noncompliance. 2 As a result, medication noncompliance accounts for approximately 33% of the cost of relapse and rehospitalization of patients with chronic schizophrenia. 2 Long-acting depot neuroleptics have been shown to enhance medication compliance and thereby reduce the risk of relapse and, consequently, hospital days. 3 In the United Kingdom, 50% of patients with schizophrenia receive treatment with long-acting, injectable depot neuroleptic therapy, while in this country only 10% to 20% receive depot therapy. 4 If US psychiatrists began to use depot neuroleptics as widely as their European colleagues, millions of dollars in relapse- and rehospitalization-related costs could be saved each year. 2 Another reason that depot neuroleptics are

The effect of management practices on stress in farmed red deer ( Cervus elaphus) and its modulation by long-acting neuroleptics: behavioural responses

Eighteen red deer hinds were used to study the behavioural responses over a period of 10 weeks to three management practices which were expected to cause increasing levels of stress. The practices were herding, herding and handling and herding, handling and a veterinary procedure. One of three groups of six animals received a long-acting neuroleptic (LAN—perphenzine enanthate and zuclopenthixol acetate) in Weeks 1, 5 and 9 of the experiment whilst the other groups were untreated. The LAN-treated and one of the untreated groups received the stressors in sequence and one undisturbed group acted as a control. The siting of the paddocks in which the three groups were rotated had a marked effect on behaviour: the further the deer were from the handling area, the less stress-related behaviour they exhibited. In response to the management procedures animals decreased their inactive lying and increased their moving activity. Based on behavioural responses the deer did not appear to find the practices increasingly challenging. Behaviour type was the chief influence on interindividual distancing. Differences in distancing between animals were most noticeable while the animals were moving. LAN treatment promoted maintenance of a more normal activity pattern when the animals were disturbed.

Psychodynamic Aspects of Psychopharmacology in Functional Somatic Complaints

Psychiatrists as well as general practitioners frequently prescribe psychotropic drugs (tranquilizers such as benzodiazepines and increasingly low-dose long-acting neuroleptics) to treat functional organic complaints. We are interested in finding out the psychodynamics in the doctor-patient relationship that determine whether the doctor puts more emphasis on eliminating symptoms by prescribing psychotropic drugs or on solving the underlying conflicts by psychotherapy. Furthermore we describe some interactions which are of importance for illustrating whether drugs are effective or lead to side effects.

Abnormal involuntary movements in patients on long-acting neuroleptics

1. 1. Two hundred and thirty eight patients (144 males, 94 females) on long-acting neuroleptics; mainly fluphenazine decanoate, were surveyed and evaluated for abnormal involuntary movements and associated risk factors. 2. 2. A highly significant correlation was found between the three scales used in the evaluation. 3. 3. The prevalence rate for the transient, acute extrapyramidal syndrome was 37.38%, while that of tardive dyskinesia was 57%. Half of the tardive dyskinesia cases were of minimal severity. Most of these were located in orofacial region. 4. 4. Tardive dyskinesia was more frequent in younger patients but more severe in older age groups. Other associated risk factors were tremors and rigidity, and use of antiparkinsonien drugs. 5. 5. Tardive dyskinesia is a common abnormal involuntary movement in patients on long-acting neuroleptic. Early recognition of TD in this population could help in planning for its prevention by the use of minimum effective dose of medication.

Effects of fluphenazine decanoate (a long-acting phenothiazine) on serum prolactin and amphetamine-induced behavioural changes

A single injection of fluphenazine decanoate (FD) antagonized effects of acute d-amphetamine (2.5 mg/kg) for a variable period of time (4 to 28 days), depending upon the dosage of the neuroleptic used (2.5 or 5.0 mg/kg) and the behavioural parameter(s) monitored. Locomotion and rearing were antagonized for a longer duration than was sniffing. Normal locomotor response to amphetamine was attained 12 and 28 days following the administration of 2.5 and 5.0 mg/kg FD, respectively. However, the 2.5 mg/kg FD group displayed significantly more locomotor activity on days 20 and 24 post-treatment. A similar supersensitive response was not demonstrable with the higher dose of FD (5.0 mg/kg), or with the other behavioural measures. The prompt and pronounced elevation of serum prolactin returned to within the normal range by days 4 and 14, following administration of 2.5 and 5.0 mg/kg FD, respectively. These results indicate that the behavioural paradigm is more sensitive in monitoring the effects of FD and could serve as a useful model in investigating the dose- and time-related effects of other long-acting neuroleptics.

Rapid parenteral treatment of acute psychosis

In the past 25 years, there has been widespread use of pharmacotherapy for the management of psychotic disturbances. Refinements in drug therapy have brought specific methods for particular clinical problems, such as megadose treatment for refractory patients 1,2 and maintenance therapy using conventional and long-acting neuroleptics to facilitate community adjustment. 3,4 For the management of acute psychosis, a number of oral and parenteral procedures, employing a variety of neuroleptic agents and dosage schedules, are described in the literature as “rapid” treatment techniques. However, there is lack of agreement about the terms used in describing these techniques as well as lack of clarity about their relative efficacy. More specifically, at the present time it is unclear whether there is advantage to administering neuroleptic by frequent injections over a period of hours, and whether administering neuroleptic via different routes (intramuscular, intravenous, or oral) results in different rates of therapeutic change. This article reviews the use of rapid parenteral techniques, and considers the evidence regarding the safety and effectiveness of these procedures for the management of acute psychosis.