Pearls

A side from posing a psychiatric emergency, agitation can also signal a potentially serious medical problem (Box). After the patient’s behavior is stabilized, a medical evaluation may be necessary. The letters that spell “agitation” remind us to watch for these problems:

Alcohol dependence, intoxication, or withdrawal can lead to agitation even when obvious signs or symptoms of alcohol use are not present.¹ Watch for nausea, vomiting, tremors, sweating, auditory or visual hallucinations, headaches, and abnormal vital signs. Also watch for confusion, which may precede delirium.

Genetics. Agitation is a presenting symptom in several congenital diseases, such as Huntington’s disease.² Look for Huntington’s chorea, psychotic symptoms, and family history of a congenital disease associated with agitation.

Infections. Agitation in patients with systemic, local, or CNS infections may be seen as psychogenic, thereby delaying medical evaluation.³ Watch for abnormal vital signs, especially fever or sweating. General achiness could signal meningitis, a viral infection prodrome, or tetanus infection.

Tumors. Patients with primary cancer with CNS metastasis or primary CNS tumors may present with agitation but no other symptoms or signs of cancer.⁴ Find out if the patient has a personal or family history of cancer. Watch for unexplained pain that cannot be adequately controlled.

Akathisia. Inner psychological restlessness and observable movements associated with akathisia can manifest as agitation.⁵ Ask whether the patient is using illicit drugs or medications (eg, some antipsychotics) that may cause akathisia.

Trauma. Agitated patients with brain injuries caused by surgery, burns, or heatstroke usually present with obvious clinical signs. However, persons with asymptomatic, undiagnosed bone and skull fractures may also become agitated.⁶ Elderly and frail persons and patients with a past head injury also are at risk for trauma-related agitation.

Box

Illicit drugs. Agitation may point to drug intoxication, addiction, or withdrawal. Do a urine and blood screen to check for use of stimulants, anabolic steroids, ketamine, phencyclidine (PCP), or “club drugs” such as methylenedioxymethamphetamine (MDMA, or Ecstasy) and gamma hydroxybutyrate (GHB).⁷

Other predisposing medical factors for agitation include chronic pain, respiratory distress, and endocrine and metabolic abnormalities.^1,2,7,8 Refer the patient for a medical workup, including laboratory and diagnostic tests based on lab results.

Neuropsychiatric conditions. Agitation may be the main presenting symptom of seizures, as well as:

• degenerative CNS diseases such as Parkinson’s disease, multiple sclerosis, and dementias, especially the Alzheimer’s type
  
• Tourette syndrome
  
• a pervasive developmental disorder
  
• inherited movement disorders, such as Wilson’s disease or Hallervorden-Spatz syndrome.^2,8-10
  

Get a detailed patient and family history, then refer the patient for comprehensive physical and neurologic examinations.

Acknowledgments

The authors thank Leonard D. Williams, PA, and Drs. Nestor Manzano, Craig Campbell, Scott Ahles, Robert Hierholzer, and Avak Howsepian for their help.

A side from posing a psychiatric emergency, agitation can also signal a potentially serious medical problem (Box). After the patient’s behavior is stabilized, a medical evaluation may be necessary. The letters that spell “agitation” remind us to watch for these problems:

Alcohol dependence, intoxication, or withdrawal can lead to agitation even when obvious signs or symptoms of alcohol use are not present.¹ Watch for nausea, vomiting, tremors, sweating, auditory or visual hallucinations, headaches, and abnormal vital signs. Also watch for confusion, which may precede delirium.

Genetics. Agitation is a presenting symptom in several congenital diseases, such as Huntington’s disease.² Look for Huntington’s chorea, psychotic symptoms, and family history of a congenital disease associated with agitation.

Infections. Agitation in patients with systemic, local, or CNS infections may be seen as psychogenic, thereby delaying medical evaluation.³ Watch for abnormal vital signs, especially fever or sweating. General achiness could signal meningitis, a viral infection prodrome, or tetanus infection.

Tumors. Patients with primary cancer with CNS metastasis or primary CNS tumors may present with agitation but no other symptoms or signs of cancer.⁴ Find out if the patient has a personal or family history of cancer. Watch for unexplained pain that cannot be adequately controlled.

Akathisia. Inner psychological restlessness and observable movements associated with akathisia can manifest as agitation.⁵ Ask whether the patient is using illicit drugs or medications (eg, some antipsychotics) that may cause akathisia.

Trauma. Agitated patients with brain injuries caused by surgery, burns, or heatstroke usually present with obvious clinical signs. However, persons with asymptomatic, undiagnosed bone and skull fractures may also become agitated.⁶ Elderly and frail persons and patients with a past head injury also are at risk for trauma-related agitation.

Box

Illicit drugs. Agitation may point to drug intoxication, addiction, or withdrawal. Do a urine and blood screen to check for use of stimulants, anabolic steroids, ketamine, phencyclidine (PCP), or “club drugs” such as methylenedioxymethamphetamine (MDMA, or Ecstasy) and gamma hydroxybutyrate (GHB).⁷

Other predisposing medical factors for agitation include chronic pain, respiratory distress, and endocrine and metabolic abnormalities.^1,2,7,8 Refer the patient for a medical workup, including laboratory and diagnostic tests based on lab results.

Neuropsychiatric conditions. Agitation may be the main presenting symptom of seizures, as well as:

• degenerative CNS diseases such as Parkinson’s disease, multiple sclerosis, and dementias, especially the Alzheimer’s type
  
• Tourette syndrome
  
• a pervasive developmental disorder
  
• inherited movement disorders, such as Wilson’s disease or Hallervorden-Spatz syndrome.^2,8-10
  

Get a detailed patient and family history, then refer the patient for comprehensive physical and neurologic examinations.

Acknowledgments

The authors thank Leonard D. Williams, PA, and Drs. Nestor Manzano, Craig Campbell, Scott Ahles, Robert Hierholzer, and Avak Howsepian for their help.

A side from posing a psychiatric emergency, agitation can also signal a potentially serious medical problem (Box). After the patient’s behavior is stabilized, a medical evaluation may be necessary. The letters that spell “agitation” remind us to watch for these problems:

Alcohol dependence, intoxication, or withdrawal can lead to agitation even when obvious signs or symptoms of alcohol use are not present.¹ Watch for nausea, vomiting, tremors, sweating, auditory or visual hallucinations, headaches, and abnormal vital signs. Also watch for confusion, which may precede delirium.

Genetics. Agitation is a presenting symptom in several congenital diseases, such as Huntington’s disease.² Look for Huntington’s chorea, psychotic symptoms, and family history of a congenital disease associated with agitation.

Infections. Agitation in patients with systemic, local, or CNS infections may be seen as psychogenic, thereby delaying medical evaluation.³ Watch for abnormal vital signs, especially fever or sweating. General achiness could signal meningitis, a viral infection prodrome, or tetanus infection.

Tumors. Patients with primary cancer with CNS metastasis or primary CNS tumors may present with agitation but no other symptoms or signs of cancer.⁴ Find out if the patient has a personal or family history of cancer. Watch for unexplained pain that cannot be adequately controlled.

Akathisia. Inner psychological restlessness and observable movements associated with akathisia can manifest as agitation.⁵ Ask whether the patient is using illicit drugs or medications (eg, some antipsychotics) that may cause akathisia.

Trauma. Agitated patients with brain injuries caused by surgery, burns, or heatstroke usually present with obvious clinical signs. However, persons with asymptomatic, undiagnosed bone and skull fractures may also become agitated.⁶ Elderly and frail persons and patients with a past head injury also are at risk for trauma-related agitation.

Box

Illicit drugs. Agitation may point to drug intoxication, addiction, or withdrawal. Do a urine and blood screen to check for use of stimulants, anabolic steroids, ketamine, phencyclidine (PCP), or “club drugs” such as methylenedioxymethamphetamine (MDMA, or Ecstasy) and gamma hydroxybutyrate (GHB).⁷

Other predisposing medical factors for agitation include chronic pain, respiratory distress, and endocrine and metabolic abnormalities.^1,2,7,8 Refer the patient for a medical workup, including laboratory and diagnostic tests based on lab results.

Neuropsychiatric conditions. Agitation may be the main presenting symptom of seizures, as well as:

• degenerative CNS diseases such as Parkinson’s disease, multiple sclerosis, and dementias, especially the Alzheimer’s type
  
• Tourette syndrome
  
• a pervasive developmental disorder
  
• inherited movement disorders, such as Wilson’s disease or Hallervorden-Spatz syndrome.^2,8-10
  

Get a detailed patient and family history, then refer the patient for comprehensive physical and neurologic examinations.

Acknowledgments

The authors thank Leonard D. Williams, PA, and Drs. Nestor Manzano, Craig Campbell, Scott Ahles, Robert Hierholzer, and Avak Howsepian for their help.

Many physicians communicate with patients or colleagues via e-mail but lose this connectivity when they travel. If you find traditional home and office e-mail accounts are no longer enough, several e-mail access options can help you stay connected anytime.

How e-mail works

Typical home e-mail accounts-known as post office protocol (POP) accounts-use a client-server access method. The client-such as Outlook Express, Eudora, or Netscape Mail-checks the server for mail, which is then downloaded onto the home computer. Once downloaded, the message is gone from the server.

By contrast, an Internet message access protocol (IMAP) account offers more capabilities, such as allowing users to store e-mail on the server and organize mail into folders.^{December 2003). Also, some public locations such as New York’s Bryant Park offer free wireless Internet as a public service.2 Personal digital assistants or notebook computers with wireless capability, such as the Tungsten TC or the Toshiba e800, are best suited to this type of access.}

Dial-up Internet service is possible over your cell phone. Most mobile phone carriers charge extra for data transmission, and you will need a specific cable to connect your phone to your computer. Bluetooth wireless technology can eliminate the need for cables but beware: Data transfer is much slower with Bluetooth than with other methods.

Third-generation networks (3G)-higher-speed protocols that allow faster data transmission for multimedia-have been touted as the next best service from mobile phone providers. Wireless devices such as the Palm Treo or the Research in Motion BlackBerry are specifically designed for this type of access. Monthly data service costs approximately $30 for unlimited downloads or less when bundled with a voice plan. Access is limited to the cellular coverage area, however.

Wireless access protocol, an alternative to 3G, lets you access e-mail via your mobile phone. This service, available from mobile service providers for an additional monthly fee (about $10), lets you read mail on the phone screen, but there are several drawbacks:

• Some people may find the text too small to read.
• Text entry via the telephone keypad can be difficult. You either tap a key multiple times to select letters or use word prediction based on letters entered.
• Not all phones available for each carrier can perform this function.

Wireless access protocol is well suited to reading e-mails. To compose an e-mail, however, you need to choose letters by clicking on numbers, which can be very difficult.

Many physicians communicate with patients or colleagues via e-mail but lose this connectivity when they travel. If you find traditional home and office e-mail accounts are no longer enough, several e-mail access options can help you stay connected anytime.

How e-mail works

Typical home e-mail accounts-known as post office protocol (POP) accounts-use a client-server access method. The client-such as Outlook Express, Eudora, or Netscape Mail-checks the server for mail, which is then downloaded onto the home computer. Once downloaded, the message is gone from the server.

By contrast, an Internet message access protocol (IMAP) account offers more capabilities, such as allowing users to store e-mail on the server and organize mail into folders.^{December 2003). Also, some public locations such as New York’s Bryant Park offer free wireless Internet as a public service.2 Personal digital assistants or notebook computers with wireless capability, such as the Tungsten TC or the Toshiba e800, are best suited to this type of access.}

Dial-up Internet service is possible over your cell phone. Most mobile phone carriers charge extra for data transmission, and you will need a specific cable to connect your phone to your computer. Bluetooth wireless technology can eliminate the need for cables but beware: Data transfer is much slower with Bluetooth than with other methods.

Third-generation networks (3G)-higher-speed protocols that allow faster data transmission for multimedia-have been touted as the next best service from mobile phone providers. Wireless devices such as the Palm Treo or the Research in Motion BlackBerry are specifically designed for this type of access. Monthly data service costs approximately $30 for unlimited downloads or less when bundled with a voice plan. Access is limited to the cellular coverage area, however.

Wireless access protocol, an alternative to 3G, lets you access e-mail via your mobile phone. This service, available from mobile service providers for an additional monthly fee (about $10), lets you read mail on the phone screen, but there are several drawbacks:

• Some people may find the text too small to read.
• Text entry via the telephone keypad can be difficult. You either tap a key multiple times to select letters or use word prediction based on letters entered.
• Not all phones available for each carrier can perform this function.

Wireless access protocol is well suited to reading e-mails. To compose an e-mail, however, you need to choose letters by clicking on numbers, which can be very difficult.

Many physicians communicate with patients or colleagues via e-mail but lose this connectivity when they travel. If you find traditional home and office e-mail accounts are no longer enough, several e-mail access options can help you stay connected anytime.

How e-mail works

Typical home e-mail accounts-known as post office protocol (POP) accounts-use a client-server access method. The client-such as Outlook Express, Eudora, or Netscape Mail-checks the server for mail, which is then downloaded onto the home computer. Once downloaded, the message is gone from the server.

By contrast, an Internet message access protocol (IMAP) account offers more capabilities, such as allowing users to store e-mail on the server and organize mail into folders.^{December 2003). Also, some public locations such as New York’s Bryant Park offer free wireless Internet as a public service.2 Personal digital assistants or notebook computers with wireless capability, such as the Tungsten TC or the Toshiba e800, are best suited to this type of access.}

Dial-up Internet service is possible over your cell phone. Most mobile phone carriers charge extra for data transmission, and you will need a specific cable to connect your phone to your computer. Bluetooth wireless technology can eliminate the need for cables but beware: Data transfer is much slower with Bluetooth than with other methods.

Third-generation networks (3G)-higher-speed protocols that allow faster data transmission for multimedia-have been touted as the next best service from mobile phone providers. Wireless devices such as the Palm Treo or the Research in Motion BlackBerry are specifically designed for this type of access. Monthly data service costs approximately $30 for unlimited downloads or less when bundled with a voice plan. Access is limited to the cellular coverage area, however.

Wireless access protocol, an alternative to 3G, lets you access e-mail via your mobile phone. This service, available from mobile service providers for an additional monthly fee (about $10), lets you read mail on the phone screen, but there are several drawbacks:

• Some people may find the text too small to read.
• Text entry via the telephone keypad can be difficult. You either tap a key multiple times to select letters or use word prediction based on letters entered.
• Not all phones available for each carrier can perform this function.

Wireless access protocol is well suited to reading e-mails. To compose an e-mail, however, you need to choose letters by clicking on numbers, which can be very difficult.

Pediatric overweight and obesity can cause serious health problems later on. Use of psychotropics associated with potential weight gain compounds this risk.

Convincing youths to exercise and eat healthier foods can help them maintain a normal weight for their age and gender (see “Choose precise BMI charts to track youths’ weight gain,” (Current Psychiatry, October 2004,).

Cutting calories

Discuss the fat and calorie content of popular high-fat foods with the parents, who can then encourage their child to make more-informed dietary choices. Explain, for example, that it takes all day to burn the calories in two doughnuts, one fast-food bacon cheeseburger, or one extra-large serving of fast-food french fries.

A table listing portions of high-fat foods equaling 500 Kcal—the amount of energy a typical youth burns in 1 day through brisk walking—accompanies this article at www.currentpsychiatry.com.

Increasing exercise

Physical activity declines substantially during adolescence.¹ In youths with chronic mental illness, reduced activity may contribute more than increased caloric intake to overweight/obesity.

Tell youths that they can lose 1 lb of body fat per week with normal walking and can lose more weight by simply taking a 30-minute walk each day. Alternately, each of the following activities burns as many Kcal as a 30-minute walk:

• jumping rope 11 minutes
  
• jogging 13 minutes
  
• swimming 19 minutes
  
• moderate cycling 24 minutes
  
• mowing lawn 30 minutes.
  

The pedometer is attached to the belt near the buckle and records a step every time the hip drops. Pedometers measure activity by steps per day; they cannot gauge activity on a bicycle.

Assuming that a youth burns 40 Kcal per 1,000 steps, a child will burn 480 to 640 Kcal and an adolescent will burn 440 to 480 Kcal per day through brisk walking. Burning 500 Kcal/day translates to 3,500 Kcal—the equivalent of 1 lb of body fat—across 1 week.

Encouraging exercise. It is harder to promote exercise to a chronically mentally ill youth than to a youth who is not mentally ill. Work with the patient’s family, case manager, school system, teacher, nurse, and/or family doctor or pediatrician to plan an exercise regimen.

Pediatric overweight and obesity can cause serious health problems later on. Use of psychotropics associated with potential weight gain compounds this risk.

Convincing youths to exercise and eat healthier foods can help them maintain a normal weight for their age and gender (see “Choose precise BMI charts to track youths’ weight gain,” (Current Psychiatry, October 2004,).

Cutting calories

Discuss the fat and calorie content of popular high-fat foods with the parents, who can then encourage their child to make more-informed dietary choices. Explain, for example, that it takes all day to burn the calories in two doughnuts, one fast-food bacon cheeseburger, or one extra-large serving of fast-food french fries.

A table listing portions of high-fat foods equaling 500 Kcal—the amount of energy a typical youth burns in 1 day through brisk walking—accompanies this article at www.currentpsychiatry.com.

Increasing exercise

Physical activity declines substantially during adolescence.¹ In youths with chronic mental illness, reduced activity may contribute more than increased caloric intake to overweight/obesity.

Tell youths that they can lose 1 lb of body fat per week with normal walking and can lose more weight by simply taking a 30-minute walk each day. Alternately, each of the following activities burns as many Kcal as a 30-minute walk:

• jumping rope 11 minutes
  
• jogging 13 minutes
  
• swimming 19 minutes
  
• moderate cycling 24 minutes
  
• mowing lawn 30 minutes.
  

The pedometer is attached to the belt near the buckle and records a step every time the hip drops. Pedometers measure activity by steps per day; they cannot gauge activity on a bicycle.

Assuming that a youth burns 40 Kcal per 1,000 steps, a child will burn 480 to 640 Kcal and an adolescent will burn 440 to 480 Kcal per day through brisk walking. Burning 500 Kcal/day translates to 3,500 Kcal—the equivalent of 1 lb of body fat—across 1 week.

Encouraging exercise. It is harder to promote exercise to a chronically mentally ill youth than to a youth who is not mentally ill. Work with the patient’s family, case manager, school system, teacher, nurse, and/or family doctor or pediatrician to plan an exercise regimen.

Pediatric overweight and obesity can cause serious health problems later on. Use of psychotropics associated with potential weight gain compounds this risk.

Convincing youths to exercise and eat healthier foods can help them maintain a normal weight for their age and gender (see “Choose precise BMI charts to track youths’ weight gain,” (Current Psychiatry, October 2004,).

Cutting calories

Discuss the fat and calorie content of popular high-fat foods with the parents, who can then encourage their child to make more-informed dietary choices. Explain, for example, that it takes all day to burn the calories in two doughnuts, one fast-food bacon cheeseburger, or one extra-large serving of fast-food french fries.

A table listing portions of high-fat foods equaling 500 Kcal—the amount of energy a typical youth burns in 1 day through brisk walking—accompanies this article at www.currentpsychiatry.com.

Increasing exercise

Physical activity declines substantially during adolescence.¹ In youths with chronic mental illness, reduced activity may contribute more than increased caloric intake to overweight/obesity.

Tell youths that they can lose 1 lb of body fat per week with normal walking and can lose more weight by simply taking a 30-minute walk each day. Alternately, each of the following activities burns as many Kcal as a 30-minute walk:

• jumping rope 11 minutes
  
• jogging 13 minutes
  
• swimming 19 minutes
  
• moderate cycling 24 minutes
  
• mowing lawn 30 minutes.
  

The pedometer is attached to the belt near the buckle and records a step every time the hip drops. Pedometers measure activity by steps per day; they cannot gauge activity on a bicycle.

Assuming that a youth burns 40 Kcal per 1,000 steps, a child will burn 480 to 640 Kcal and an adolescent will burn 440 to 480 Kcal per day through brisk walking. Burning 500 Kcal/day translates to 3,500 Kcal—the equivalent of 1 lb of body fat—across 1 week.

Encouraging exercise. It is harder to promote exercise to a chronically mentally ill youth than to a youth who is not mentally ill. Work with the patient’s family, case manager, school system, teacher, nurse, and/or family doctor or pediatrician to plan an exercise regimen.

It’s the holiday season. You’ve got better things to think about than your computers’ security and data accessibility.

Many “tech toys” can help secure your computers and let you August 2004.)

Still, notebook computers are easy to steal, and desktop computers can be stolen or infiltrated. To secure your data, you need encryption to supplement password-restricted access. Also, you should regularly save and copy data in an alternate location.

Solutions. The Authenex HDLock is a universal serial bus (USB) key that encrypts your hard drive’s contents. The device uses “two-factor authentication,” a security method that blocks access until you provide something you have (the key) and something you know (the password). Without both the key and password, encrypted data cannot be accessed. If you lose the key or forget the password, an online support section provides a one-time password.

If more than one person needs access, the Silex Technology FUS-200N USB fingerprint reader is more appropriate. This device and its accompanying software:

• provide secured access for multiple users
• encrypt files and folders
• and force users to show their fingerprints before allowing access to selected programs, such as your medical records program.

The FUS-200N is more accurate than other fingerprint recognition devices because it uses electricity rather than light patterns to record fingerprints.

Another option, the DiskOnKey Classic 2.0 USB flash drive, includes a small built-in microprocessor that lets you run your electronic medical records program or other applications from the key. CapMed uses this key to allow consumers to store their medical information on the Personal HealthKey device.

See Table 1 for more information on these security enhancement programs.

Storage

Problem. When shuttling between home and office, it makes sense to carry files on a USB flash drive. These devices are great for transporting documents because the computer sees a flash drive as just another disk drive.

Flash drives, however, are easily lost—and no psychiatrist wants to be sued for losing sensitive information.

Solutions. Some USB flash drives, such as the Sony Micro Vault, offer password protection for files and folders. Another option, the Trek Thumbdrive Touch, has a built-in fingerprint reader to guard your data (Table 2).

If you already have a favorite USB flash drive, add quick- and easy-to-use encryption software to your home and office computers. AxCrypt, a free Windows-compatible program, lets you encrypt and decrypt files with a simple right-mouse click. A similar program, Fairly Good Privacy, is Mac OS-compatible (Table 1).

Synchronization/remote access

Problem. You need to access critical files in both your office and home computer from either location.

Solutions. Internet-based synchronization services can simultaneously update files on both computers (Table 3). fusionOne Plus, for example, keeps files, contacts, e-mail, and calendars in sync. Contacts and calendars can also be accessed and synchronized via some mobile phones. What’s more, FusionOne Plus provides an online backup copy of your files.

LogMeIn provides free secured remote access to your office files from any computer. After your install a server program on the host computer, you can run programs and open files via a Web browser. The LogMeIn Pro version, which costs $12.95 per month, adds the ability to synchronize computers, transfer files, and distribute them over the Internet.

GoToMyPC allows you to access files and programs on a host computer and also allows Pocket PC PDA viewing as well as remote printing, but it does not provide file synchronization.

For direct computer-to-computer connection, pcAnywhere and RealVNC allow you to access files and programs on the host computer. Unlike GoToMyPC and LogMeIn, however, these programs do not offer additional password protection by verifying the user’s account.

The $200 PC Anywhere program will encrypt data between computers, whereas the free RealVNC program only provides password security. PC Anywhere synchronizes file, whereas RealVNC only helps you run the remote computer. RealVNC has enterprise versions and is developing a personal version with additional features.

Online storage can help you avoid synchronization issues. Xdrive has desktop software that creates a virtual drive for storage. When starting your computer, the software will automatically connect via the Internet to your Xdrive account. You can also change the settings of your electronic medical records program or document editing software to save data only to this Internet drive. This way, your data will always be backed up to a safe location even if your home or office computer is stolen.

Table 1

Programs, services that enhance data security

Table 2

Secure flash drives

Table 3

Programs, services that facilitate remote data access

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

poll here

It’s the holiday season. You’ve got better things to think about than your computers’ security and data accessibility.

Many “tech toys” can help secure your computers and let you August 2004.)

Still, notebook computers are easy to steal, and desktop computers can be stolen or infiltrated. To secure your data, you need encryption to supplement password-restricted access. Also, you should regularly save and copy data in an alternate location.

Solutions. The Authenex HDLock is a universal serial bus (USB) key that encrypts your hard drive’s contents. The device uses “two-factor authentication,” a security method that blocks access until you provide something you have (the key) and something you know (the password). Without both the key and password, encrypted data cannot be accessed. If you lose the key or forget the password, an online support section provides a one-time password.

If more than one person needs access, the Silex Technology FUS-200N USB fingerprint reader is more appropriate. This device and its accompanying software:

• provide secured access for multiple users
• encrypt files and folders
• and force users to show their fingerprints before allowing access to selected programs, such as your medical records program.

The FUS-200N is more accurate than other fingerprint recognition devices because it uses electricity rather than light patterns to record fingerprints.

Another option, the DiskOnKey Classic 2.0 USB flash drive, includes a small built-in microprocessor that lets you run your electronic medical records program or other applications from the key. CapMed uses this key to allow consumers to store their medical information on the Personal HealthKey device.

See Table 1 for more information on these security enhancement programs.

Storage

Problem. When shuttling between home and office, it makes sense to carry files on a USB flash drive. These devices are great for transporting documents because the computer sees a flash drive as just another disk drive.

Flash drives, however, are easily lost—and no psychiatrist wants to be sued for losing sensitive information.

Solutions. Some USB flash drives, such as the Sony Micro Vault, offer password protection for files and folders. Another option, the Trek Thumbdrive Touch, has a built-in fingerprint reader to guard your data (Table 2).

If you already have a favorite USB flash drive, add quick- and easy-to-use encryption software to your home and office computers. AxCrypt, a free Windows-compatible program, lets you encrypt and decrypt files with a simple right-mouse click. A similar program, Fairly Good Privacy, is Mac OS-compatible (Table 1).

Synchronization/remote access

Problem. You need to access critical files in both your office and home computer from either location.

Solutions. Internet-based synchronization services can simultaneously update files on both computers (Table 3). fusionOne Plus, for example, keeps files, contacts, e-mail, and calendars in sync. Contacts and calendars can also be accessed and synchronized via some mobile phones. What’s more, FusionOne Plus provides an online backup copy of your files.

LogMeIn provides free secured remote access to your office files from any computer. After your install a server program on the host computer, you can run programs and open files via a Web browser. The LogMeIn Pro version, which costs $12.95 per month, adds the ability to synchronize computers, transfer files, and distribute them over the Internet.

GoToMyPC allows you to access files and programs on a host computer and also allows Pocket PC PDA viewing as well as remote printing, but it does not provide file synchronization.

For direct computer-to-computer connection, pcAnywhere and RealVNC allow you to access files and programs on the host computer. Unlike GoToMyPC and LogMeIn, however, these programs do not offer additional password protection by verifying the user’s account.

The $200 PC Anywhere program will encrypt data between computers, whereas the free RealVNC program only provides password security. PC Anywhere synchronizes file, whereas RealVNC only helps you run the remote computer. RealVNC has enterprise versions and is developing a personal version with additional features.

Online storage can help you avoid synchronization issues. Xdrive has desktop software that creates a virtual drive for storage. When starting your computer, the software will automatically connect via the Internet to your Xdrive account. You can also change the settings of your electronic medical records program or document editing software to save data only to this Internet drive. This way, your data will always be backed up to a safe location even if your home or office computer is stolen.

Table 1

Programs, services that enhance data security

Table 2

Secure flash drives

Table 3

Programs, services that facilitate remote data access

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

poll here

It’s the holiday season. You’ve got better things to think about than your computers’ security and data accessibility.

Many “tech toys” can help secure your computers and let you August 2004.)

Still, notebook computers are easy to steal, and desktop computers can be stolen or infiltrated. To secure your data, you need encryption to supplement password-restricted access. Also, you should regularly save and copy data in an alternate location.

Solutions. The Authenex HDLock is a universal serial bus (USB) key that encrypts your hard drive’s contents. The device uses “two-factor authentication,” a security method that blocks access until you provide something you have (the key) and something you know (the password). Without both the key and password, encrypted data cannot be accessed. If you lose the key or forget the password, an online support section provides a one-time password.

If more than one person needs access, the Silex Technology FUS-200N USB fingerprint reader is more appropriate. This device and its accompanying software:

• provide secured access for multiple users
• encrypt files and folders
• and force users to show their fingerprints before allowing access to selected programs, such as your medical records program.

The FUS-200N is more accurate than other fingerprint recognition devices because it uses electricity rather than light patterns to record fingerprints.

Another option, the DiskOnKey Classic 2.0 USB flash drive, includes a small built-in microprocessor that lets you run your electronic medical records program or other applications from the key. CapMed uses this key to allow consumers to store their medical information on the Personal HealthKey device.

See Table 1 for more information on these security enhancement programs.

Storage

Problem. When shuttling between home and office, it makes sense to carry files on a USB flash drive. These devices are great for transporting documents because the computer sees a flash drive as just another disk drive.

Flash drives, however, are easily lost—and no psychiatrist wants to be sued for losing sensitive information.

Solutions. Some USB flash drives, such as the Sony Micro Vault, offer password protection for files and folders. Another option, the Trek Thumbdrive Touch, has a built-in fingerprint reader to guard your data (Table 2).

If you already have a favorite USB flash drive, add quick- and easy-to-use encryption software to your home and office computers. AxCrypt, a free Windows-compatible program, lets you encrypt and decrypt files with a simple right-mouse click. A similar program, Fairly Good Privacy, is Mac OS-compatible (Table 1).

Synchronization/remote access

Problem. You need to access critical files in both your office and home computer from either location.

Solutions. Internet-based synchronization services can simultaneously update files on both computers (Table 3). fusionOne Plus, for example, keeps files, contacts, e-mail, and calendars in sync. Contacts and calendars can also be accessed and synchronized via some mobile phones. What’s more, FusionOne Plus provides an online backup copy of your files.

LogMeIn provides free secured remote access to your office files from any computer. After your install a server program on the host computer, you can run programs and open files via a Web browser. The LogMeIn Pro version, which costs $12.95 per month, adds the ability to synchronize computers, transfer files, and distribute them over the Internet.

GoToMyPC allows you to access files and programs on a host computer and also allows Pocket PC PDA viewing as well as remote printing, but it does not provide file synchronization.

For direct computer-to-computer connection, pcAnywhere and RealVNC allow you to access files and programs on the host computer. Unlike GoToMyPC and LogMeIn, however, these programs do not offer additional password protection by verifying the user’s account.

The $200 PC Anywhere program will encrypt data between computers, whereas the free RealVNC program only provides password security. PC Anywhere synchronizes file, whereas RealVNC only helps you run the remote computer. RealVNC has enterprise versions and is developing a personal version with additional features.

Online storage can help you avoid synchronization issues. Xdrive has desktop software that creates a virtual drive for storage. When starting your computer, the software will automatically connect via the Internet to your Xdrive account. You can also change the settings of your electronic medical records program or document editing software to save data only to this Internet drive. This way, your data will always be backed up to a safe location even if your home or office computer is stolen.

Table 1

Programs, services that enhance data security

Table 2

Secure flash drives

Table 3

Programs, services that facilitate remote data access

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

poll here

Can knowing a patient’s environmental stressors and family history help us more quickly diagnose bipolar mania?

Kessing et al¹ studied patients who were diagnosed as having mania or a mixed episode during their first psychiatric hospitalization. They found that certain life events were associated with these diagnoses, reinforcing the belief that environment to some extent influences psychiatric illness.

Although more research is needed, this finding may help psychiatrists reach a diagnosis of bipolar mania when the clinical course is unclear. Life events that may contribute to bipolar mania are remembered with the mnemonic MANIAS:

• Marital status change. The patient recently was married, divorced, or lost a significant other to death.
• Family Admission. The patient’s mother, father, or sibling was hospitalized at some point for a psychiatric disorder. It does not seem to matter whether the patient remembers the family member’s hospitalization.
• No work. The patient is unemployed.
• Inability to work. The patient is disabled or collects disability benefits.
• Abstaining from relationships. The patient does not have a significant other.
• Suicide was completed by the patient’s mother, father, or sibling. It does not matter how long ago or at what point in the patient’s life the suicide happened.

Can knowing a patient’s environmental stressors and family history help us more quickly diagnose bipolar mania?

Kessing et al¹ studied patients who were diagnosed as having mania or a mixed episode during their first psychiatric hospitalization. They found that certain life events were associated with these diagnoses, reinforcing the belief that environment to some extent influences psychiatric illness.

Although more research is needed, this finding may help psychiatrists reach a diagnosis of bipolar mania when the clinical course is unclear. Life events that may contribute to bipolar mania are remembered with the mnemonic MANIAS:

• Marital status change. The patient recently was married, divorced, or lost a significant other to death.
• Family Admission. The patient’s mother, father, or sibling was hospitalized at some point for a psychiatric disorder. It does not seem to matter whether the patient remembers the family member’s hospitalization.
• No work. The patient is unemployed.
• Inability to work. The patient is disabled or collects disability benefits.
• Abstaining from relationships. The patient does not have a significant other.
• Suicide was completed by the patient’s mother, father, or sibling. It does not matter how long ago or at what point in the patient’s life the suicide happened.

Can knowing a patient’s environmental stressors and family history help us more quickly diagnose bipolar mania?

Kessing et al¹ studied patients who were diagnosed as having mania or a mixed episode during their first psychiatric hospitalization. They found that certain life events were associated with these diagnoses, reinforcing the belief that environment to some extent influences psychiatric illness.

Although more research is needed, this finding may help psychiatrists reach a diagnosis of bipolar mania when the clinical course is unclear. Life events that may contribute to bipolar mania are remembered with the mnemonic MANIAS:

• Marital status change. The patient recently was married, divorced, or lost a significant other to death.
• Family Admission. The patient’s mother, father, or sibling was hospitalized at some point for a psychiatric disorder. It does not seem to matter whether the patient remembers the family member’s hospitalization.
• No work. The patient is unemployed.
• Inability to work. The patient is disabled or collects disability benefits.
• Abstaining from relationships. The patient does not have a significant other.
• Suicide was completed by the patient’s mother, father, or sibling. It does not matter how long ago or at what point in the patient’s life the suicide happened.

Children and adolescents with a chronic mental illness face a much higher risk for obesity than do healthy youths. Use of one or more psychotropics associated with weight gain compounds common adolescent risk factors, including:

• increased eating
• reduced physical activity
• genetic, developmental, and environmental factors.

Use of body mass index (BMI) measurements based on sex and age in percentiles—instead of the usual height and weight—can help psychiatrists more accurately monitor psychotropic-induced weight gain and the effects of diet and exercise in youths.

Why: sex/age percentiles?

Child/adolescent growth charts show considerable BMI variations based on sex and age. Simply recording height, weight and serial BMI changes—as is done for adults—does not adequately reflect deviations from expected growth patterns. Trying to determine medication effect by combining height and weight measurements of youths of differing sex and age is particularly misleading.

Consider these examples, based on the Centers for Disease Control and Prevention (CDC) growth chart for boys ages 2 to 20 years:

• A BMI of 18 kg/m²would place a 5-year-old boy at the 95th percentile (obese), an 8-year-boy at the 85th percentile (overweight), and a 16.5-year-old boy at the 10th percentile (underweight).
• An 8.5-year-old boy with a BMI of 16 kg/m² is in the 50th percentile, meaning his weight is normal for his age and gender. To remain in the 50th percentile at age 16, his BMI must increase to 20.5 kg/m².

Available: tools

CDC publishes sex- and age-specific growth charts (www.cdc.gov/growthcharts) that are easy to understand and use.

CDC considers children and adolescents with BMIs at or above the 95th percentile as “overweight,” and those between the 85th and 95th percentiles as “at risk for overweight.” Others use the terms “obese” and “overweight” for these same percentiles.

For greater precision, CDC also offers free Epi Info software downloads (www.cdc.gov/epi-info). This includes the NutStat anthropometric program, which calculates percentiles and Z scores—number of standard deviations from the mean—from CDC’s 2000 growth charts.

Using NutStat and patient age, clinicians can quickly calculate BMI, percentile, and Z score. Staff can enter height, weight, date of birth, and date of measurement into the module and generate these numbers for clinical decision making and documentation.

Children and adolescents with a chronic mental illness face a much higher risk for obesity than do healthy youths. Use of one or more psychotropics associated with weight gain compounds common adolescent risk factors, including:

• increased eating
• reduced physical activity
• genetic, developmental, and environmental factors.

Use of body mass index (BMI) measurements based on sex and age in percentiles—instead of the usual height and weight—can help psychiatrists more accurately monitor psychotropic-induced weight gain and the effects of diet and exercise in youths.

Why: sex/age percentiles?

Child/adolescent growth charts show considerable BMI variations based on sex and age. Simply recording height, weight and serial BMI changes—as is done for adults—does not adequately reflect deviations from expected growth patterns. Trying to determine medication effect by combining height and weight measurements of youths of differing sex and age is particularly misleading.

Consider these examples, based on the Centers for Disease Control and Prevention (CDC) growth chart for boys ages 2 to 20 years:

• A BMI of 18 kg/m²would place a 5-year-old boy at the 95th percentile (obese), an 8-year-boy at the 85th percentile (overweight), and a 16.5-year-old boy at the 10th percentile (underweight).
• An 8.5-year-old boy with a BMI of 16 kg/m² is in the 50th percentile, meaning his weight is normal for his age and gender. To remain in the 50th percentile at age 16, his BMI must increase to 20.5 kg/m².

Available: tools

CDC publishes sex- and age-specific growth charts (www.cdc.gov/growthcharts) that are easy to understand and use.

CDC considers children and adolescents with BMIs at or above the 95th percentile as “overweight,” and those between the 85th and 95th percentiles as “at risk for overweight.” Others use the terms “obese” and “overweight” for these same percentiles.

For greater precision, CDC also offers free Epi Info software downloads (www.cdc.gov/epi-info). This includes the NutStat anthropometric program, which calculates percentiles and Z scores—number of standard deviations from the mean—from CDC’s 2000 growth charts.

Using NutStat and patient age, clinicians can quickly calculate BMI, percentile, and Z score. Staff can enter height, weight, date of birth, and date of measurement into the module and generate these numbers for clinical decision making and documentation.

Children and adolescents with a chronic mental illness face a much higher risk for obesity than do healthy youths. Use of one or more psychotropics associated with weight gain compounds common adolescent risk factors, including:

• increased eating
• reduced physical activity
• genetic, developmental, and environmental factors.

Use of body mass index (BMI) measurements based on sex and age in percentiles—instead of the usual height and weight—can help psychiatrists more accurately monitor psychotropic-induced weight gain and the effects of diet and exercise in youths.

Why: sex/age percentiles?

Child/adolescent growth charts show considerable BMI variations based on sex and age. Simply recording height, weight and serial BMI changes—as is done for adults—does not adequately reflect deviations from expected growth patterns. Trying to determine medication effect by combining height and weight measurements of youths of differing sex and age is particularly misleading.

Consider these examples, based on the Centers for Disease Control and Prevention (CDC) growth chart for boys ages 2 to 20 years:

• A BMI of 18 kg/m²would place a 5-year-old boy at the 95th percentile (obese), an 8-year-boy at the 85th percentile (overweight), and a 16.5-year-old boy at the 10th percentile (underweight).
• An 8.5-year-old boy with a BMI of 16 kg/m² is in the 50th percentile, meaning his weight is normal for his age and gender. To remain in the 50th percentile at age 16, his BMI must increase to 20.5 kg/m².

Available: tools

CDC publishes sex- and age-specific growth charts (www.cdc.gov/growthcharts) that are easy to understand and use.

CDC considers children and adolescents with BMIs at or above the 95th percentile as “overweight,” and those between the 85th and 95th percentiles as “at risk for overweight.” Others use the terms “obese” and “overweight” for these same percentiles.

For greater precision, CDC also offers free Epi Info software downloads (www.cdc.gov/epi-info). This includes the NutStat anthropometric program, which calculates percentiles and Z scores—number of standard deviations from the mean—from CDC’s 2000 growth charts.

Using NutStat and patient age, clinicians can quickly calculate BMI, percentile, and Z score. Staff can enter height, weight, date of birth, and date of measurement into the module and generate these numbers for clinical decision making and documentation.

In a practice that lives on frequent typing and computer use, repetitive strain injuries pose an occupational hazard. These painful injuries can dampen quality of life and disable you or a staff member.

The best way to deal with repetitive strain injuries is to avoid them. Here are some simple precautions.

How repetitive strain injuries happen

Repetitive strain injuries result from repeated physical movements. Symptoms vary, but include tightness, stiffness, soreness, or burning in the hands, wrists, fingers, and/or elbows. Tingling, coldness, or numbness in these joints may also occur. Persons with such injuries might be awoken at night by the pain, or they may lose strength and coordination and become clumsy. Pain after a few seconds of typing may signal a repetitive strain injury, as can moderate wrist pain after typing a lengthy document.

Computer typing and mouse use require repeated movements that strain or damage tendons, nerves, and muscles in the hands, arms, wrists, shoulders, and neck. A touch typist who can type fast without looking at the keyboard is at higher risk of repetitive strain injuries than a slower typist who “hunts and pecks” at keys, because slower typing does not cause as much strain.

Today’s medicolegal climate, however, demands that clinicians keep legible (ie, electronic) records, which means additional typing and clicking for you and your staff.

What is worse, computers often are placed in spots for which they were not designed, making mouse and keyboard work awkward and physically taxing. This is particularly true in older hospitals, where charting areas typically were designed for writing but not typing.

Prevention strategies

Harvard RSI Action, a Harvard University student group dedicated to repetitive strain injury education and prevention, offers the following advice:^{Text-entry solutions: which ‘type’ is right for you ?” Psyber Psychiatry, February 2003). Do not type if you cannot do so for more than 10 minutes without pain.1}

Voice recognition software not only processes text but can also be used for Web browsing, launching applications, sending e-mail, and completing forms. But although this technology has improved dramatically in recent years, it is not yet 100% accurate or integrated into all computer applications used by physicians. Popular voice recognition programs include Scansoft Dragon Naturally Speaking and IBM ViaVoice.

Related resources

Typing Injury Frequently Asked Questions. http://www.tifaq.com

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of CURRENT PSYCHIATRY.

In a practice that lives on frequent typing and computer use, repetitive strain injuries pose an occupational hazard. These painful injuries can dampen quality of life and disable you or a staff member.

The best way to deal with repetitive strain injuries is to avoid them. Here are some simple precautions.

How repetitive strain injuries happen

Repetitive strain injuries result from repeated physical movements. Symptoms vary, but include tightness, stiffness, soreness, or burning in the hands, wrists, fingers, and/or elbows. Tingling, coldness, or numbness in these joints may also occur. Persons with such injuries might be awoken at night by the pain, or they may lose strength and coordination and become clumsy. Pain after a few seconds of typing may signal a repetitive strain injury, as can moderate wrist pain after typing a lengthy document.

Computer typing and mouse use require repeated movements that strain or damage tendons, nerves, and muscles in the hands, arms, wrists, shoulders, and neck. A touch typist who can type fast without looking at the keyboard is at higher risk of repetitive strain injuries than a slower typist who “hunts and pecks” at keys, because slower typing does not cause as much strain.

Today’s medicolegal climate, however, demands that clinicians keep legible (ie, electronic) records, which means additional typing and clicking for you and your staff.

What is worse, computers often are placed in spots for which they were not designed, making mouse and keyboard work awkward and physically taxing. This is particularly true in older hospitals, where charting areas typically were designed for writing but not typing.

Prevention strategies

Harvard RSI Action, a Harvard University student group dedicated to repetitive strain injury education and prevention, offers the following advice:^{Text-entry solutions: which ‘type’ is right for you ?” Psyber Psychiatry, February 2003). Do not type if you cannot do so for more than 10 minutes without pain.1}

Voice recognition software not only processes text but can also be used for Web browsing, launching applications, sending e-mail, and completing forms. But although this technology has improved dramatically in recent years, it is not yet 100% accurate or integrated into all computer applications used by physicians. Popular voice recognition programs include Scansoft Dragon Naturally Speaking and IBM ViaVoice.

Related resources

Typing Injury Frequently Asked Questions. http://www.tifaq.com

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of CURRENT PSYCHIATRY.

In a practice that lives on frequent typing and computer use, repetitive strain injuries pose an occupational hazard. These painful injuries can dampen quality of life and disable you or a staff member.

The best way to deal with repetitive strain injuries is to avoid them. Here are some simple precautions.

How repetitive strain injuries happen

Repetitive strain injuries result from repeated physical movements. Symptoms vary, but include tightness, stiffness, soreness, or burning in the hands, wrists, fingers, and/or elbows. Tingling, coldness, or numbness in these joints may also occur. Persons with such injuries might be awoken at night by the pain, or they may lose strength and coordination and become clumsy. Pain after a few seconds of typing may signal a repetitive strain injury, as can moderate wrist pain after typing a lengthy document.

Computer typing and mouse use require repeated movements that strain or damage tendons, nerves, and muscles in the hands, arms, wrists, shoulders, and neck. A touch typist who can type fast without looking at the keyboard is at higher risk of repetitive strain injuries than a slower typist who “hunts and pecks” at keys, because slower typing does not cause as much strain.

Today’s medicolegal climate, however, demands that clinicians keep legible (ie, electronic) records, which means additional typing and clicking for you and your staff.

What is worse, computers often are placed in spots for which they were not designed, making mouse and keyboard work awkward and physically taxing. This is particularly true in older hospitals, where charting areas typically were designed for writing but not typing.

Prevention strategies

Harvard RSI Action, a Harvard University student group dedicated to repetitive strain injury education and prevention, offers the following advice:^{Text-entry solutions: which ‘type’ is right for you ?” Psyber Psychiatry, February 2003). Do not type if you cannot do so for more than 10 minutes without pain.1}

Voice recognition software not only processes text but can also be used for Web browsing, launching applications, sending e-mail, and completing forms. But although this technology has improved dramatically in recent years, it is not yet 100% accurate or integrated into all computer applications used by physicians. Popular voice recognition programs include Scansoft Dragon Naturally Speaking and IBM ViaVoice.

Related resources

Typing Injury Frequently Asked Questions. http://www.tifaq.com

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of CURRENT PSYCHIATRY.

Conversion disorders result from stress expressed as a physical symptom. Extreme psychological stress after a death, loss, or trauma can manifest as weakness, paralysis, blindness, deafness, or mutism.

Intravenous amobarbital (Amytal)—so-called “truth serum”—is highly effective for extreme conversion symptoms without psychogenic seizures.¹ Clinicians who are not skilled in hypnosis might consider amobarbital after ruling out a neurologic or organic cause.

USING AMOBARBITAL

Amobarbital—100 to 500 mg for adults, 25 to 50 mg for children—is given slowly over 10 to 15 minutes and usually works rapidly. Stop the IV as soon as an effect is noticed or the patient starts feeling drowsy.

Other side effects include disinhibition, which may help the patient overcome his or her stress. Amobarbital is contraindicated during pregnancy and in patients with:

• pulmonary disease, as it may slow respiration
• porphyria, an iron metabolism disorder that can be exacerbated with barbiturate use.²

When interviewing a patient before amobarbital treatment, I focus solely on symptom relief. Follow-up psychotherapy can then help the patient understand what caused the stress.

CASE 1: BLINDING VISION

Mr. A, age 25, was hospitalized after complaining he was “blind.” Neurologic and medical examination and brain CT showed no abnormalities. History revealed that Mr. A had a hemorrhoid and was curious about how it looked. He was startled upon seeing the hemorrhoid, after which he had trouble seeing.

The psychiatrist gave amobarbital, 300 mg IV over 30 minutes. Fifteen minutes into the medication, Mr. A began to see shadows, leaves, then people. After another 15 minutes, his sight was normal. He was discharged that day; psychiatric follow-up was arranged.

CASE 2: ON THE SIDELINES

Joey, age 9, was admitted to the pediatric unit after developing acute paralysis. Neurologic and medical work-ups, including CT, were negative.

When I visited him, Joey told me that he was anxious about going to school. I gave him amobarbital, 25 mg over 15 minutes. Then, because he told me he is a football fan, I had Joey imagine that he was a pro quarterback. Within minutes Joey was jogging up and down the hallway. He was discharged; outpatient psychiatric follow-up was scheduled.

Conversion disorders result from stress expressed as a physical symptom. Extreme psychological stress after a death, loss, or trauma can manifest as weakness, paralysis, blindness, deafness, or mutism.

Intravenous amobarbital (Amytal)—so-called “truth serum”—is highly effective for extreme conversion symptoms without psychogenic seizures.¹ Clinicians who are not skilled in hypnosis might consider amobarbital after ruling out a neurologic or organic cause.

USING AMOBARBITAL

Amobarbital—100 to 500 mg for adults, 25 to 50 mg for children—is given slowly over 10 to 15 minutes and usually works rapidly. Stop the IV as soon as an effect is noticed or the patient starts feeling drowsy.

Other side effects include disinhibition, which may help the patient overcome his or her stress. Amobarbital is contraindicated during pregnancy and in patients with:

• pulmonary disease, as it may slow respiration
• porphyria, an iron metabolism disorder that can be exacerbated with barbiturate use.²

When interviewing a patient before amobarbital treatment, I focus solely on symptom relief. Follow-up psychotherapy can then help the patient understand what caused the stress.

CASE 1: BLINDING VISION

Mr. A, age 25, was hospitalized after complaining he was “blind.” Neurologic and medical examination and brain CT showed no abnormalities. History revealed that Mr. A had a hemorrhoid and was curious about how it looked. He was startled upon seeing the hemorrhoid, after which he had trouble seeing.

The psychiatrist gave amobarbital, 300 mg IV over 30 minutes. Fifteen minutes into the medication, Mr. A began to see shadows, leaves, then people. After another 15 minutes, his sight was normal. He was discharged that day; psychiatric follow-up was arranged.

CASE 2: ON THE SIDELINES

Joey, age 9, was admitted to the pediatric unit after developing acute paralysis. Neurologic and medical work-ups, including CT, were negative.

When I visited him, Joey told me that he was anxious about going to school. I gave him amobarbital, 25 mg over 15 minutes. Then, because he told me he is a football fan, I had Joey imagine that he was a pro quarterback. Within minutes Joey was jogging up and down the hallway. He was discharged; outpatient psychiatric follow-up was scheduled.

Conversion disorders result from stress expressed as a physical symptom. Extreme psychological stress after a death, loss, or trauma can manifest as weakness, paralysis, blindness, deafness, or mutism.

Intravenous amobarbital (Amytal)—so-called “truth serum”—is highly effective for extreme conversion symptoms without psychogenic seizures.¹ Clinicians who are not skilled in hypnosis might consider amobarbital after ruling out a neurologic or organic cause.

USING AMOBARBITAL

Amobarbital—100 to 500 mg for adults, 25 to 50 mg for children—is given slowly over 10 to 15 minutes and usually works rapidly. Stop the IV as soon as an effect is noticed or the patient starts feeling drowsy.

Other side effects include disinhibition, which may help the patient overcome his or her stress. Amobarbital is contraindicated during pregnancy and in patients with:

• pulmonary disease, as it may slow respiration
• porphyria, an iron metabolism disorder that can be exacerbated with barbiturate use.²

When interviewing a patient before amobarbital treatment, I focus solely on symptom relief. Follow-up psychotherapy can then help the patient understand what caused the stress.

CASE 1: BLINDING VISION

Mr. A, age 25, was hospitalized after complaining he was “blind.” Neurologic and medical examination and brain CT showed no abnormalities. History revealed that Mr. A had a hemorrhoid and was curious about how it looked. He was startled upon seeing the hemorrhoid, after which he had trouble seeing.

The psychiatrist gave amobarbital, 300 mg IV over 30 minutes. Fifteen minutes into the medication, Mr. A began to see shadows, leaves, then people. After another 15 minutes, his sight was normal. He was discharged that day; psychiatric follow-up was arranged.

CASE 2: ON THE SIDELINES

Joey, age 9, was admitted to the pediatric unit after developing acute paralysis. Neurologic and medical work-ups, including CT, were negative.

When I visited him, Joey told me that he was anxious about going to school. I gave him amobarbital, 25 mg over 15 minutes. Then, because he told me he is a football fan, I had Joey imagine that he was a pro quarterback. Within minutes Joey was jogging up and down the hallway. He was discharged; outpatient psychiatric follow-up was scheduled.

Is your office computer system-and the confidential patient records it contains-safe from hackers?

Maintaining office computer security isn’t just good practice-it’s the law. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires physicians to ensure that patient records are kept confidential.^{click here.}

Hardware tokens are pocket-size devices that, when connected to the computer, allow access by entering the proper password. Hardware tokens are suitable for managing off-site remote access and add another layer of security for local access.

Medical records programs. Most software programs allow administrators to restrict access to medical records by setting up levels of ability to access and modifying electronic records for different users. Each user should have a unique password for authentication. The software also should have an audit trail capability, so that each user’s activity with electronic patient records can be reviewed.

Security breaches

An Internet connection-however brief-can invite security breaches that allow hackers to access patient information, delete programs, steal passwords, disrupt other Internet-connected computers, and erase the hard drive. Avoiding Internet connections altogether would increase security, but this is not feasible.

• Viruses reproduce using the host computer, most commonly by infiltrating the e-mail program and making it hard to detect corrupted files.
• Worms are similar to viruses but are self-contained, whereas a virus must attach to another file.
• Trojan horse programs, usually disguised within seemingly legitimate Internet programs, are less common than viruses or worms. They do not replicate but are equally dangerous. You unknowingly start the Trojan horse after downloading what looks like a useful program. The Trojan horse then self-installs silently, giving the hacker who created it access to your computer.
• Port attacks are malicious attempts to connect and eventually take over another computer. A ‘port’ is a software ‘location’ where a program on another computer can connect to a host computer.
• NEVER open e-mails from unfamiliar sources. Viruses are commonly sent as attachments, which you should never open unless you know they are safe.
• Turn off your computer or disconnect from the Internet when not in use.
• Back up your data regularly. Put patient files in one folder or directory, then copy them to a backup medium such as CD-ROM, zip drive, or portable hard drive. Of course, keep the disks in a secure place.

Anti-intrusion programs

Antivirus programs can check for the latest viruses and their variants and remove them. To do this, automatically update the program with new virus signature files- files created by antivirus program vendors to help the software identify viruses. Most antivirus programs will automatically check the vendor’s Web site for updated files if the computer is connected to the Internet.

Virus signature files should be updated daily to provide maximum protection. Most companies provide a 1-year subscription to the updates, which must be renewed upon expiration for new virus definition files.

Manual updating is acceptable but may be too time-consuming for a busy office.

Well-known antivirus programs include Wireless Internet 101,” Psyber Psychiatry, December 2003)

If your computer is connected directly to the DSL or cable modem or a telephone line, you probably need a firewall. The most recent Microsoft Windows XP and Mac OS X versions each include a software firewall, which should be activated upon installation.

Windows-compatible firewall programs include ZoneAlarm, Sygate Personal Firewall, Symantec Norton Personal Firewall, and Tiny Software Personal. Mac OS-compatible firewalls include Intego NetBarrier, Sustainable Softworks IPNetSentryX, and Norton Personal Firewall.

Once your firewall is installed, check it to verify that all ports are protected. Gibson Research Corp. has two excellent (and free) security checks: ShieldsUP! and LeakTest. Run these tests, then follow the listed suggestions to secure your computer.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of CURRENT PSYCHIATRY.

Is your office computer system-and the confidential patient records it contains-safe from hackers?

Maintaining office computer security isn’t just good practice-it’s the law. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires physicians to ensure that patient records are kept confidential.^{click here.}

Hardware tokens are pocket-size devices that, when connected to the computer, allow access by entering the proper password. Hardware tokens are suitable for managing off-site remote access and add another layer of security for local access.

Medical records programs. Most software programs allow administrators to restrict access to medical records by setting up levels of ability to access and modifying electronic records for different users. Each user should have a unique password for authentication. The software also should have an audit trail capability, so that each user’s activity with electronic patient records can be reviewed.

Security breaches

An Internet connection-however brief-can invite security breaches that allow hackers to access patient information, delete programs, steal passwords, disrupt other Internet-connected computers, and erase the hard drive. Avoiding Internet connections altogether would increase security, but this is not feasible.

• Viruses reproduce using the host computer, most commonly by infiltrating the e-mail program and making it hard to detect corrupted files.
• Worms are similar to viruses but are self-contained, whereas a virus must attach to another file.
• Trojan horse programs, usually disguised within seemingly legitimate Internet programs, are less common than viruses or worms. They do not replicate but are equally dangerous. You unknowingly start the Trojan horse after downloading what looks like a useful program. The Trojan horse then self-installs silently, giving the hacker who created it access to your computer.
• Port attacks are malicious attempts to connect and eventually take over another computer. A ‘port’ is a software ‘location’ where a program on another computer can connect to a host computer.
• NEVER open e-mails from unfamiliar sources. Viruses are commonly sent as attachments, which you should never open unless you know they are safe.
• Turn off your computer or disconnect from the Internet when not in use.
• Back up your data regularly. Put patient files in one folder or directory, then copy them to a backup medium such as CD-ROM, zip drive, or portable hard drive. Of course, keep the disks in a secure place.

Anti-intrusion programs

Antivirus programs can check for the latest viruses and their variants and remove them. To do this, automatically update the program with new virus signature files- files created by antivirus program vendors to help the software identify viruses. Most antivirus programs will automatically check the vendor’s Web site for updated files if the computer is connected to the Internet.

Virus signature files should be updated daily to provide maximum protection. Most companies provide a 1-year subscription to the updates, which must be renewed upon expiration for new virus definition files.

Manual updating is acceptable but may be too time-consuming for a busy office.

Well-known antivirus programs include Wireless Internet 101,” Psyber Psychiatry, December 2003)

If your computer is connected directly to the DSL or cable modem or a telephone line, you probably need a firewall. The most recent Microsoft Windows XP and Mac OS X versions each include a software firewall, which should be activated upon installation.

Windows-compatible firewall programs include ZoneAlarm, Sygate Personal Firewall, Symantec Norton Personal Firewall, and Tiny Software Personal. Mac OS-compatible firewalls include Intego NetBarrier, Sustainable Softworks IPNetSentryX, and Norton Personal Firewall.

Once your firewall is installed, check it to verify that all ports are protected. Gibson Research Corp. has two excellent (and free) security checks: ShieldsUP! and LeakTest. Run these tests, then follow the listed suggestions to secure your computer.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of CURRENT PSYCHIATRY.

Is your office computer system-and the confidential patient records it contains-safe from hackers?

Maintaining office computer security isn’t just good practice-it’s the law. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires physicians to ensure that patient records are kept confidential.^{click here.}

Hardware tokens are pocket-size devices that, when connected to the computer, allow access by entering the proper password. Hardware tokens are suitable for managing off-site remote access and add another layer of security for local access.

Medical records programs. Most software programs allow administrators to restrict access to medical records by setting up levels of ability to access and modifying electronic records for different users. Each user should have a unique password for authentication. The software also should have an audit trail capability, so that each user’s activity with electronic patient records can be reviewed.

Security breaches

An Internet connection-however brief-can invite security breaches that allow hackers to access patient information, delete programs, steal passwords, disrupt other Internet-connected computers, and erase the hard drive. Avoiding Internet connections altogether would increase security, but this is not feasible.

• Viruses reproduce using the host computer, most commonly by infiltrating the e-mail program and making it hard to detect corrupted files.
• Worms are similar to viruses but are self-contained, whereas a virus must attach to another file.
• Trojan horse programs, usually disguised within seemingly legitimate Internet programs, are less common than viruses or worms. They do not replicate but are equally dangerous. You unknowingly start the Trojan horse after downloading what looks like a useful program. The Trojan horse then self-installs silently, giving the hacker who created it access to your computer.
• Port attacks are malicious attempts to connect and eventually take over another computer. A ‘port’ is a software ‘location’ where a program on another computer can connect to a host computer.
• NEVER open e-mails from unfamiliar sources. Viruses are commonly sent as attachments, which you should never open unless you know they are safe.
• Turn off your computer or disconnect from the Internet when not in use.
• Back up your data regularly. Put patient files in one folder or directory, then copy them to a backup medium such as CD-ROM, zip drive, or portable hard drive. Of course, keep the disks in a secure place.

Anti-intrusion programs

Antivirus programs can check for the latest viruses and their variants and remove them. To do this, automatically update the program with new virus signature files- files created by antivirus program vendors to help the software identify viruses. Most antivirus programs will automatically check the vendor’s Web site for updated files if the computer is connected to the Internet.

Virus signature files should be updated daily to provide maximum protection. Most companies provide a 1-year subscription to the updates, which must be renewed upon expiration for new virus definition files.

Manual updating is acceptable but may be too time-consuming for a busy office.

Well-known antivirus programs include Wireless Internet 101,” Psyber Psychiatry, December 2003)

If your computer is connected directly to the DSL or cable modem or a telephone line, you probably need a firewall. The most recent Microsoft Windows XP and Mac OS X versions each include a software firewall, which should be activated upon installation.

Windows-compatible firewall programs include ZoneAlarm, Sygate Personal Firewall, Symantec Norton Personal Firewall, and Tiny Software Personal. Mac OS-compatible firewalls include Intego NetBarrier, Sustainable Softworks IPNetSentryX, and Norton Personal Firewall.

Once your firewall is installed, check it to verify that all ports are protected. Gibson Research Corp. has two excellent (and free) security checks: ShieldsUP! and LeakTest. Run these tests, then follow the listed suggestions to secure your computer.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of CURRENT PSYCHIATRY.