BPRS scores were assessed at 0, 20, 90 and 180 minutes.
This study had multiple arms and doses of ketamine but all within 0.1 – 0.5 mg/kg. Randomized, double-blind, placebo-controlled study of 18 healthy, non-schizophrenic volunteers and 17 volunteers with schizophrenia (active symptoms but stable). Effects of ketamine in normal and schizophrenic volunteers. Symptoms returned to baseline at the end of the study.Ĭonclusion: Ketamine transiently increases schizophrenic-type symptoms in healthy volunteers. BPRS scores increased from baseline particularly for conceptual disorganization and unusual thought context but not for hallucinatory behavior or anxiety-depression symptoms. Patients underwent PET scans to localize the areas of the brain that were triggered by ketamine. Ketamine was administered at 0.12 mg/kg bolus followed by 0.65 mg/kg constant infusion. Randomized, double-blind, placebo-controlled study of 17 healthy volunteers without a history of schizophrenia. Association of ketamine-induced psychosis with focal activation of the prefrontal cortex in healthy volunteers. The increase in BPRS was not seen with placebo.Ĭonclusion: Ketamine at 0.3 mg/kg and 0.5 mg/kg increases schizophrenic symptoms in the short term with a return to baseline within 90 minutes.īreier A et al. After administration of ketamine, there was an increase in the BPRS score when patients received either 0.3 or 0.5 mg/kg with a return to baseline at 90 minutes. Patients mental status was evaluated using the Brief Psychiatric Rating Scale (BPRS) at baseline and at various intervals after administration. Patients were stable but had active symptoms of psychosis. Patients were given a range of ketamine doses (0.1, 0.3 and 0.5 mg/kg) and served as their own controls. Randomized, double-blind, placebo-controlled study of 9 patients with schizophrenia. Subanesthetic doses of ketamine stimulate psychosis in schizophrenia. The ACEP Clinical Policy lists psychiatric illness as an absolute contraindication for dissociative sedation with ketamine ( Green 2011).Ĭlinical Question: What is the evidence behind the contraindication of a history of psychiatric illness for ketamine and how strong is this evidence? These disturbances are short-lived in the majority of individuals but there is a fear that ketamine can cause decompensation of psychiatric illness. Ketamine is an N-methyl-D-aspartic acid (NMDA) receptor antagonist and it can produce a broad range of cognitive and behavioral disturbances including psychosis. One contraindication that persists, though, is that of a history of psychiatric illness. This includes the dogma that ketamine cannot be used in patients with head trauma (for fear of increasing the ICP) or in patients with hypertension or tachycardia.
A number of relative contraindications for ketamine exist though many of them have been debunked through analysis of the evidence. There are four major indications for the use of ketamine in the ED: analgesia with low dose ketamine (LDK), induction for rapid sequence intubation, procedural sedation and sedation of the agitated patient. Background: In recent years, ketamine use has dramatically increased in the Emergency Department (ED).
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