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Adult ADHD: 6 studies of nonpharmacologic interventions 成人ADHD: 6项非药物干预研究
Q4 Medicine Pub Date : 2023-10-01 DOI: 10.12788/cp.0398
Melody Grace Santos
Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder characterized by a persistent pattern of inattention, impulsivity, and/ or hyperactivity that causes functional impairment.1 ADHD begins in childhood, continues into adulthood, and has negative consequences in many facets of adult patients’ lives, including their careers, daily functioning, and interpersonal relationships.2 According to the National Institute of Health and Care Excellence’s recommendations, both pharmacotherapy and psychotherapy are advised for patients with ADHD.3 Although various pharmacotherapies are advised as first-line treatments for ADHD, they are frequently linked to unfavorable adverse effects, partial responses, chronic residual symptoms, high dropout rates, and issues with addiction.4 As a result, there is a need for evidence-based nonpharmacologic therapies. In a systematic review, Nimmo-Smith et al5 found that certain nonpharmacologic treatments can be effective in helping patients with ADHD manage their illness. In clinical and cognitive assessments of ADHD, a recent meta-analysis found that noninvasive brain stimulation had a small but significant effect.6 Some evidence suggests that in addition to noninvasive brain stimulation, other nonpharmacologic interventions, including psychoeducation (PE), mindfulness, cognitive-behavioral therapy (CBT), and chronotherapy, can be effective as an adjunct treatment to pharmacotherapy, and possibly as monotherapy. Part 1 of this 2-part article reviewed 6 randomized controlled trials (RCTs) of pharmacologic interventions for adult ADHD published within the last 5 years.7 Part 2 analyzes 6 RCTs of nonpharmacologic treatments for adult ADHD published within the last 5 years (Table,8-13 page 33).
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引用次数: 0
Emotional blunting in patients taking antidepressants 服用抗抑郁药患者的情绪钝化
Q4 Medicine Pub Date : 2023-10-01 DOI: 10.12788/cp.0392
Gemma Espejo
When used to treat anxiety or depressive disorders, antidepressants can cause a variety of adverse effects, including emotional blunting. Emotional blunting has been described as emotional numbness, indifference, decreased responsiveness, or numbing. In a study of 669 patients who had been receiving antidepressants (selective serotonin reuptake inhibitors [SSRIs], serotonin-norepinephrine reuptake inhibitors [SNRIs], or other antidepressants), 46% said they had experienced emotional blunting.1 A 2019 study found that approximately one-third of patients with unipolar depression or bipolar depression stopped taking their antidepressant due to emotional blunting.2 Historically, there has been difficulty parsing out emotional blunting (a general decrease of all range of emotions) from anhedonia (a restriction of positive emotions). Additionally, some researchers have questioned if the blunting of emotions is part of depressive symptomatology. In a study of 38 adults, most felt able to differentiate emotional blunting due to antidepressants by considering the resolution of other depressive symptoms and timeline of onset.3 A significant limitation has been how clinicians measure or assess emotional blunting. The Oxford Depression Questionnaire (ODQ), previously known as the Oxford Questionnaire on the Emotional Side-effects of Antidepressants, was created based on a qualitative survey of patients who endorsed emotional blunting.4 A validated scale, the ODQ divides emotional blunting into 4 dimensions: • general reduction in emotions • reduction in positive emotions • emotional detachment from others • not caring.4 The sections of ODQ focus on exploring specific aspects of patients’ emotional experiences, comparing experiences in the past week to before the development of illness/ emotional blunting, and patients’ opinions about antidepressants. Example statements from the ODQ (Table,4 page 47) may help clinicians better understand and explore emotional blunting with their patients. There are 2 leading theories behind the mechanism of emotional blunting on antidepressants, both focused on serotonin. The first theory offers that SSRIs alter frontal lobe activity through serotonergic effects. The second theory is focused on the downward effects of serotonin on dopamine in reward pathways.5
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引用次数: 0
A street medicine view of tobacco use in patients with schizophrenia 精神分裂症患者烟草使用的街头医学观点
Q4 Medicine Pub Date : 2023-10-01 DOI: 10.12788/cp.0404
John W Figg
Throughout my psychiatric clerkship, I (JWF) participated in street medicine, the practice of providing care to patients (typically those who are homeless) at the location they currently reside, such as in a homeless encampment or community shelter. Our clinical team drove to locations that provided housing for patients diagnosed with schizophrenia, where we assisted with medications and blood draws. I remember pulling up the first day and seeing someone outside smoking a cigarette. I soon learned that many people living in such situations were smokers, and that among the substances they used, tobacco was the most common. One patient said the cigarettes helped him manage the “voices in his head” as well as some of the adverse effects from medication, such as parkinsonism and akathisia. I asked my attending physician about this and she explained that for some patients, using tobacco was a way to mitigate the positive symptoms of schizophrenia and make the adverse effects of their therapy, particularly extrapyramidal symptoms (EPS), more bearable. By the end of my 2-week rotation, I was sure of a trend: our patients with schizophrenia smoked incessantly. Near the end of my rotation, I asked a patient, “Why do you smoke”? The patient looked at me, puzzled, and replied: “I just do.” This exchange only piqued my curiosity, and I could not help but wonder: what is the relationship between tobacco use and schizophrenia? How is tobacco use related to the pathophysiology of schizophrenia? Does tobacco use among patients with schizophrenia ameliorate aspects of their psychosis? Street medicine offered me a window into a biomedically intriguing question, and I wanted to learn more.
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引用次数: 0
The pandemic has permanently changed us, and its biopsychosocial sequelae linger… 大流行已经永久地改变了我们,它的生物、心理和社会后遗症挥之不去……
Q4 Medicine Pub Date : 2023-10-01 DOI: 10.12788/cp.0402
Henry A Nasrallah
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引用次数: 0
ADHD in older adults: A closer look 老年人多动症:近距离观察
Q4 Medicine Pub Date : 2023-09-01 DOI: 10.12788/cp.0381
Van Ngo
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引用次数: 0
Abnormal sexual behaviors in frontotemporal dementia 额颞叶痴呆患者的异常性行为
Q4 Medicine Pub Date : 2023-09-01 DOI: 10.12788/cp.0382
Alivia D Price
M r. S, age 77, is admitted to a longterm care facility due to progressive cognitive impairment and sexually inappropriate behavior. He has a history of sexual assault of medical staff. His medical history includes significant frontotemporal dementia (FTD) with behavioral disturbances, abnormal sexual behaviors, subclinical hypothyroidism, schizoid personality disorder, Parkinson disease, posttraumatic stress disorder, and hyperammonemia. Upon admission, Mr. S’s vital signs are within normal limits except for an elevated thyroid-stimulating hormone (4.54 mIU/L; reference range 0.40 to 4.50 mIU/L). Prior cognitive testing results and updated ammonia levels are unavailable. Mr. S’s current medications include acetaminophen 650 mg every 4 hours as needed for pain, calcium carbonate/vitamin D twice daily for bone health, carbidopa/levodopa 25/100 mg twice daily for Parkinson disease, melatonin 3 mg/d at bedtime for insomnia, quetiapine 25 mg twice daily for psychosis with disturbance of behavior and 12.5 mg every 4 hours as needed for agitation, and trazodone 50 mg/d at bedtime for insomnia. Before Mr. S was admitted, previous therapy with selective serotonin reuptake inhibitors (SSRIs) had been tapered and discontinued. Mr. S had also started antipsychotic therapy at another facility due to worsening behaviors.
现年77岁的M.r.S因渐进性认知障碍和性行为不当被送入长期护理机构。他有性侵医务人员的历史。他的病史包括严重的额颞叶痴呆(FTD),伴有行为障碍、异常性行为、亚临床甲状腺功能减退、精神分裂症人格障碍、帕金森病、创伤后应激障碍和高氨血症。入院后,S先生的生命体征在正常范围内,但促甲状腺激素升高除外(4.54 mIU/L;参考范围0.40至4.50 mIU/L)。先前的认知测试结果和更新的氨水平不可用。S先生目前的药物包括对乙酰氨基酚每4小时650毫克,用于治疗疼痛,碳酸钙/维生素D每天两次,用于骨骼健康,卡比多巴/左旋多巴25/100毫克,用于帕金森病,褪黑素每天3毫克,用于失眠,喹硫平25毫克,用于行为障碍的精神病,每天两次,曲唑酮50 mg/d用于治疗失眠。在S入院之前,以前使用选择性血清素再摄取抑制剂(SSRIs)的治疗已经逐渐减少并停止。由于行为恶化,S先生也在另一家机构开始了抗精神病药物治疗。
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引用次数: 0
How to avoid abandonment claims when terminating care 终止护理时如何避免放弃索赔
Q4 Medicine Pub Date : 2023-09-01 DOI: 10.12788/cp.0391
K. Joshi
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引用次数: 0
A toxic and fractured political system can breed angst and PTSD 一个有毒且支离破碎的政治体系会滋生焦虑和创伤后应激障碍
Q4 Medicine Pub Date : 2023-09-01 DOI: 10.12788/cp.0393
Henry A. Nasrallah
Perhaps one of the worst experiences for a child is to witness bitterly adversarial parents (their vital role models) who argue viciously, despise each other, and hurl insults (and even punches) at each other. Such a chronically and emotionally traumatic upbringing can haunt kids well into adulthood, disrupting their hypothalamic-pituitary-adrenal axis and triggering anxiety, depression, and even psychosis due to epigenetic changes that ultimately lead to abnormal brain development.3 It often feels that the governance of our country, or the national “political family,” is seriously fractured like a hopelessly dysfunctional family. Could that be negatively impacting the mental health of the citizenry? Having 2 antagonistic political parties expressing visceral hatred and undisguised contempt for each other 24/7 (thanks to the enabling era of cable TV, the internet, and social media) has transformed each party’s fanatic followers from fellow citizens to ideological combatants. In this poisonous societal zeitgeist of bidirectional acrimony and mutual detestation, the opposing parties and their “intellectual militias” label each other as “extremists” or “radicals.” They become completely blind to any redeeming social value in the ideas or principles of their political opponents. They spend enormous time and energy on undermining each other instead of attending to the myriad vital issues involved in the governance of a massive and complex country. Winston Churchill said, “Democracy is the worst form of government, except for all the others that have been tried.”4 The current toxic cloud of intense “hyperpartisanship” is emblematic of the dark Machiavellian side of democracy. But those who lament the current distorted version of democracy should contemplate living in a dictatorship or totalitarian regime, where a despot would execute any dissenter or invade and destroy an adjacent country at a whim. Churchill made that statement in 1947. The internet, social media, and smartphones were science fiction back then. Those technological advances have added fuel to the political process and significantly stoked the flames of hyperpartisanship. It’s now democracy on steroids, where freedom of expression The governance of our country is fractured like a dysfunctional family and could be negatively impacting the mental health of the citizenry Henry A. Nasrallah, MD, DLFAPA Editor-in-Chief
也许对一个孩子来说,最糟糕的经历之一就是目睹敌对的父母(他们的重要榜样)恶狠狠地争吵,鄙视对方,谩骂(甚至拳脚相向)。这种长期的、情感上的创伤性成长会困扰孩子直到成年,扰乱他们的下丘脑-垂体-肾上腺轴,引发焦虑、抑郁,甚至由于表观遗传变化而导致的精神病,最终导致大脑发育异常它经常觉得,我们国家的治理,或国家的“政治家庭”,像一个无望的功能失调的家庭一样严重破裂。这会对市民的心理健康产生负面影响吗?由于有线电视、互联网和社交媒体的发展,两个敌对的政党全天候表达发自内心的仇恨和毫不掩饰的蔑视,这使得两党的狂热追随者从同胞变成了意识形态上的斗士。在这种双向尖酸刻薄、相互憎恨的有毒社会思潮中,对立的政党和他们的“知识分子民兵”互相给对方贴上“极端分子”或“激进分子”的标签。他们完全看不到政治对手的思想或原则中任何可取的社会价值。他们把大量的时间和精力花在相互破坏上,而不是关注治理一个庞大而复杂的国家所涉及的无数重要问题。温斯顿·丘吉尔说过:“民主是最糟糕的政府形式,除了所有其他被尝试过的形式。”当前强烈的“超党派之争”的毒云象征着民主中马基雅维利主义的阴暗面。但是,那些哀叹当前民主被扭曲的人应该考虑生活在一个独裁或极权政权中,在那里,暴君会随心所欲地处决任何持不同政见者,或者入侵并摧毁邻国。丘吉尔在1947年发表了这一声明。互联网、社交媒体和智能手机在当时都是科幻小说。这些技术进步为政治进程火上浇油,极大地点燃了党派之争的火焰。我们国家的治理就像一个功能失调的家庭一样支离破碎,可能会对公民的心理健康产生负面影响
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引用次数: 0
More on prescribing controlled substances 更多关于开具受控物质的处方
Q4 Medicine Pub Date : 2023-09-01 DOI: 10.12788/cp.0395
Jeff Sanders
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引用次数: 0
Crafting a dynamic learning environment during psychiatry clerkships 在精神病学实习期间营造一个充满活力的学习环境
Q4 Medicine Pub Date : 2023-09-01 DOI: 10.12788/cp.0394
Victor Ajluni
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Current psychiatry
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