Search

Delirium is a commonly occurring complex neuropsychiatric disorder. Evidence for its treatment based on randomized controlled trials is poor. The aim of this study is to determine the efficacy and acceptability of quetiapine in the treatment of delirium.

The psychological needs of patients with cancer have been increasingly recognised. Those with cancers of the head and neck have previously been found to be at relatively high risk of developing mental health difficulties after diagnosis and treatment. To provide for their psychological needs a mental health liaison nurse was attached to the local maxillofacial surgery unit for a trial period of 18 months. Fifty-eight different patients out of a total possible 63 were seen on a total of 102 occasions. The main difficulties encountered were issues of adjustment. Ten patients required brief intervention and treatment as inpatients, and only two required treatment as outpatients. Most interventions were psychological and facilitated the normal adjustment process. Given the appreciable degree of psychopathology, we advocate a stepped care approach to deal with patients' mental health needs. Initial assessment, information, and support would be provided by ward-based staff with appropriate training and supervision. Patients who were identified as having more complex needs would be seen by a mental health liaison specialist.

Various theories have been proposed to explain the development and maintenance of post-traumatic stress disorder (PTSD). This article reviews psychological and social theories that have been influential. The most prominent current theories – emotional processing, dual representation, and the cognitive model of PTSD – draw on earlier work, in particular conditioning, information processing, and classical cognitive theory. Psychodynamic and attachment theory have also influenced thinking in this area. The latest theories combine stimulus and response elements with meaning, interpretation, and appraisal; they argue that successful processing depends on being able to access and assimilate new information within pre-existing schemas. Social factors are also recognized as playing a significant role in the development and maintenance of PTSD. These are considered along with the contention that PTSD is a socio-political construct as opposed to a true disease.

Our understanding of the neurobiology of post-traumatic stress disorder (PTSD) has improved significantly in recent years. Previous work on the development of fear and memory has underpinned subsequent research that has focused on PTSD. It is now well established that specific areas of the brain are key to the development and maintenance of PTSD. These include the amygdala, hippocampus and medial prefrontal cortex, a popular current hypothesis being that the former is overactive in PTSD due to failure of the other areas to regulate its activity sufficiently. In addition to specific areas of the brain, it is now known that hormones and neurotransmitters such as cortisol and noradrenaline appear to play major roles in PTSD. This article provides an overview of current knowledge in this area.