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Lithium-Induced Hyperparathyroidism: An Ill-defined Territory. 锂诱导的甲状旁腺功能亢进:一个不明确的领域。
Q3 Medicine Pub Date : 2021-06-01
Vishwanath Pattan, Balwinder Singh, Sahar S Abdelmoneim, Chaitra Gopinath, Vishnu Sundaresh

Lithium is the gold standard treatment for bipolar disorder. Studies have shown an association between lithium and hyperparathyroidism. However, there is limited data regarding the management of lithium-induced hyperparathyroidism. We present a clinical conundrum which physicians frequently encounter-an excellent lithium responder refractory to other treatments who developed lithium-induced hyperparathyroidism. Medical treatment with cinacalcet was successful in management of hyperparathyroidism without discontinuing lithium maintenance therapy.

锂是治疗双相情感障碍的金标准。研究表明锂与甲状旁腺功能亢进之间存在关联。然而,关于锂诱导的甲状旁腺功能亢进的治疗数据有限。我们提出了一个临床难题,医生经常遇到一个优秀的锂反应难的其他治疗谁发展锂诱导甲状旁腺功能亢进。用cinacalcet治疗甲状旁腺功能亢进症是成功的,没有停止锂维持治疗。
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引用次数: 0
Consistently Modest Antidepressant Effects in Clinical Trials: the Role of Regulatory Requirements. 临床试验中持续适度的抗抑郁药物效果:监管要求的作用。
Q3 Medicine Pub Date : 2021-06-01
Arif Khan, Kaysee Fahl Mar, Walter A Brown

Despite being widely heralded following their discovery, the effectiveness and clinical utility of antidepressants has been questioned, in part due to the release of several decades of regulatory trial data. Upon investigation, contemporary regulatory trials of antidepressants have demonstrated a nearly identical effect size (0.3) for the past 40 years, regardless of placebo response or attempts to improve trial design. In this review, we examine the historical methods of antidepressant trials and re-evaluate regulatory trial data over time and according to drug class (SSRIs, SNRIs, and atypicals) with the addition of two classes of antidepressants not previously analyzed: tricyclics used as active comparators and the recently-approved NMDA receptor antagonist, esketamine. We show that among these five classes of antidepressants there were no significant differences between effect sizes or percent symptom reduction. We suggest that within the context of a regulatory trial of antidepressants, effect sizes will remain modest (~0.3) regardless of class or novel drug mechanism, possibly due to regulatory changes to trial design and conduct following the Kefauver-Harris Act of 1962. We comment that the regulatory double-blind, parallel, placebo-controlled trial model is an artificial creation for a narrow purpose-designed to demonstrate simple superiority over placebo and to determine basic safety. We should be cautious of stretching trial results beyond their limited capacity to inform clinical practice as trials are not representative of real-world patients or medication management practices. There is a substantial need to develop more realistic models to evaluate the clinical utility of antidepressants.

尽管抗抑郁药在发现后得到了广泛的宣传,但其有效性和临床效用一直受到质疑,部分原因是数十年监管试验数据的公布。根据调查,当代抗抑郁药物的监管试验表明,在过去的40年里,不管安慰剂反应或尝试改进试验设计,几乎相同的效应量(0.3)。在这篇综述中,我们研究了抗抑郁药试验的历史方法,并根据药物类别(SSRIs, SNRIs和非典型药物)重新评估了随着时间推移的监管试验数据,并添加了两类以前未分析的抗抑郁药:三环类药物作为活性比较剂和最近批准的NMDA受体拮抗剂艾氯胺酮。我们表明,在这五类抗抑郁药中,效果大小或症状减轻百分比之间没有显着差异。我们认为,在抗抑郁药监管试验的背景下,无论药物类别或新药机制如何,效应量将保持适度(~0.3),这可能是由于1962年Kefauver-Harris法案对试验设计和实施的监管变化。我们认为,监管性双盲、平行、安慰剂对照试验模型是为狭隘目的而人为创造的,旨在证明安慰剂优于安慰剂的简单优势,并确定基本安全性。由于试验不能代表现实世界的患者或药物管理实践,我们应该谨慎地将试验结果扩展到其有限的临床实践能力之外。有必要开发更现实的模型来评估抗抑郁药的临床效用。
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引用次数: 0
Long Acting Injectables and their Correlation with Subjectivity in Schizophrenia Spectrum Disorder. 长效注射剂及其与精神分裂症谱系障碍主体性的关系。
Q3 Medicine Pub Date : 2021-06-01
Ivano Caselli, Alessandra Gasparini, Marta Ielmini, Giulia Lucca, Stefano Amorosi, Nicola Poloni, Camilla Callegari

Nowadays, mental illness can no longer be considered as a mere list of symptoms corresponding to localized brain dysfunctions but rather as a disturbance of the patient's subjectivity. Thus, a solid, qualitative study of patients' subjectivity could represent a useful tool in the complex evaluation of efficacy of pharmacotherapy in schizophrenic persons. In this perspective, authors performed a phenomenological oriented investigation on 49 patients, diagnosed with schizophrenia spectrum disorder, who were receiving long-acting injectable (LAI) antipsychotic therapy. From data analysis, authors found a positive correlation between general psychopathology and the use of LAI antipsychotic therapies. The present study highlighted the necessity of a careful investigation of patients' subjectivity in a phenomenological way as an irreducible part of both psychopathological and psychopharmacological matters.

如今,精神疾病不能再被视为仅仅是一系列与局部脑功能障碍相对应的症状,而是患者主体性的一种紊乱。因此,一个坚实的,定性的研究病人的主观性可以代表一个有用的工具,在复杂的评估精神分裂症患者的药物治疗的疗效。从这个角度来看,作者对49例被诊断为精神分裂症谱系障碍的患者进行了现象学取向的调查,这些患者正在接受长效注射抗精神病药物治疗。从数据分析中,作者发现一般精神病理与使用LAI抗精神病治疗之间存在正相关。目前的研究强调了以现象学的方式仔细研究患者主体性的必要性,这是精神病理学和精神药理学问题的一个不可简化的部分。
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引用次数: 0
Treatment of Insomnia with Zaleplon in HIV+ Significantly Improves Sleep and Depression. 扎来普隆治疗HIV+患者失眠可显著改善睡眠和抑郁。
Q3 Medicine Pub Date : 2021-06-01
Jennifer R Goldschmied, Arjun Sengupta, Anup Sharma, Lynne Taylor, Knashawn H Morales, Michael E Thase, Michael E Thase, Aalim Weljie, Matthew S Kayser

More than 50% of individuals who are HIV positive report insomnia, which can reduce HIV treatment adherence, impair quality of life, and contribute to metabolic dysfunction. Major depressive disorder is also highly comorbid in this population, leading to further impairment. There is evidence that treating insomnia may improve not only sleep, but depression and metabolic function, as well. The present study aimed to examine the effects of pharmacotherapeutic treatment of insomnia on sleep, depression, and metabolic functioning in individuals with HIV. 20 individuals with asymptomatic seropositive HIV and comorbid insomnia and depression were administered zaleplon for 6 weeks. Insomnia severity was assessed using the Insomnia Severity Index and Epworth Sleepiness Scale, and depression severity was assessed using the Quick Inventory of Depression, both prior to treatment and 6 weeks post treatment. Metabolomic changes were assessed using a comprehensive platform measuring ~2000 lipid features and polar metabolites. Linear mixed effects models demonstrated that 6 weeks of treatment with zaleplon significantly improved symptoms of both insomnia and depression. Metabolomic analyses also demonstrated that changes in insomnia severity were associated with significant changes in key branched chain amino acid metabolites. Our results show that improvement in insomnia is associated with reduced depressive symptoms and beneficial metabolomic changes. Additionally, changes in key branched chain amino acid metabolites following treatment may serve as useful biomarkers of treatment response.

超过50%的HIV阳性个体报告失眠,这可能降低HIV治疗的依从性,损害生活质量,并导致代谢功能障碍。重度抑郁症在这一人群中也是高度合并症,导致进一步的损害。有证据表明,治疗失眠不仅可以改善睡眠,还可以改善抑郁和代谢功能。本研究旨在探讨药物治疗失眠对HIV感染者睡眠、抑郁和代谢功能的影响。20例无症状血清HIV阳性并伴有失眠和抑郁的患者服用扎来普隆6周。在治疗前和治疗后6周,使用失眠严重程度指数和Epworth嗜睡量表评估失眠严重程度,使用抑郁症快速量表评估抑郁严重程度。代谢组学变化的评估采用综合平台测量约2000脂质特征和极性代谢物。线性混合效应模型显示,6周的扎来普隆治疗可显著改善失眠和抑郁症状。代谢组学分析还表明,失眠严重程度的变化与关键支链氨基酸代谢物的显著变化有关。我们的研究结果表明,失眠的改善与抑郁症状的减轻和有益的代谢组学变化有关。此外,治疗后关键支链氨基酸代谢物的变化可以作为治疗反应的有用生物标志物。
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引用次数: 0
Can a 'Shot' Help Prevent Youth Re-Incarceration? Case Report on Use of a Long-Acting Injectable Antipsychotic in Incarcerated Youth. “注射”能帮助防止青少年再次入狱吗?在监禁青少年中使用长效注射抗精神病药物的案例报告。
Q3 Medicine Pub Date : 2021-06-01
Arpit Aggarwal, Victoria Lindegaard
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引用次数: 0
The Role of Religiosity and Guilt in Symptomatology and Outcome of Obsessive Compulsive Disorder. 宗教信仰和内疚感在强迫症症状学和结果中的作用。
Q3 Medicine Pub Date : 2021-06-01
Kumar Rakesh, Sharma Arvind, Bansal Pir Dutt, Bahetra Mamta, Saini Bhavneesh, Moria Kavita, Kaur Navneet, Gupta Shrutika, Bansal Priyanka, Kumar Arun, Kaur Harkamal, Kaur Jagdeep

Importance: Religiosity and guilt are commonly featured in obsessive-compulsive disorders (OCD). The role of religiosity and guilt in OCD has been frequently studied in the literature and suggested that greater religiosity/spirituality, paranormal beliefs, and magical ideation have often been associated with enhanced obsessive-compulsive behavior. India being a multi-religious country, it is particularly notable that a research was required to assess the role of religiosity and guilt in symptomatology and outcome in OCD, a condition in which religious themes are often present. It has also been documented that the fear of guilt for doing something irresponsibly may lead to OCD symptoms.

Objective: The study aimed to seek the role of religiosity and guilt in symptomatology and outcome of OCD. This study also aimed to assess the pattern of symptomatology of patients with OCD and the relation between religiosity and guilt.

Settings and design: This was a single-centered, prospective study for one year with six months follow-up.

Methods and material: Fifty OCD subjects of either gender, aged between 18 years and 45 years were included in this study and were assessed using Yale-Brown Obsessive Compulsive Scale, Belief into Action Scale, and The Guilt Inventory instruments for the measurement of OCD severity, religiosity, and guilt, respectively. All the recorded data were analyzed using IBM® SPSS® version 20.1.

Results: At baseline, OCD severity was positively correlated with religiosity and guilt, while after 6-month follow-up, OCD severity was negatively correlated with religiosity and positively correlated with guilt.

Conclusion: Religiosity and guilt have significant effect on the symptomatology and outcome of OCD.

重要性:虔诚和内疚通常是强迫症(OCD)的特征。宗教信仰和内疚在强迫症中的作用在文献中经常被研究,并表明更强烈的宗教信仰/灵性,超自然信仰和神奇的想法通常与增强的强迫症行为有关。印度是一个多宗教的国家,特别值得注意的是,需要进行一项研究,以评估宗教信仰和内疚在强迫症的症状学和结果中的作用,强迫症经常出现宗教主题。也有文献表明,对不负责任的行为感到内疚可能会导致强迫症症状。目的:探讨宗教信仰和内疚感在强迫症症状学和转归中的作用。本研究亦旨在探讨强迫症患者的症状型态,以及宗教信仰与内疚感的关系。背景和设计:这是一项单中心前瞻性研究,为期一年,随访6个月。方法与材料:选取年龄在18 ~ 45岁的男女强迫症患者50例,分别采用耶鲁-布朗强迫症量表、信仰转化为行动量表和内疚量表对强迫症的严重程度、宗教虔诚度和负罪感进行评估。所有记录的数据使用IBM®SPSS®20.1版进行分析。结果:基线时,强迫症严重程度与宗教信仰和内疚感呈正相关,随访6个月后,强迫症严重程度与宗教信仰负相关,与内疚感正相关。结论:宗教信仰和内疚感对强迫症的症状和转归有显著影响。
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引用次数: 0
Struggling to find Effective Pharmacologic Options for Akathisia? B-CALM! 努力寻找有效的药物治疗静坐症?B-CALM !
Q3 Medicine Pub Date : 2021-06-01
Srinagesh Mannekote Thippaiah, Rachel E Fargason, Badari Birur

Akathisia is a movement disorder affecting the trunk and limbs, characterized by subjective and objective restlessness. Key signs include continual, repetitive rocking, leg shuffling, and fidgeting. Antipsychotic-induced akathisia is optimally managed by reducing the medication dose or switching to a second generation antipsychotic that is less prone to inducing akathisia. However, since medication changes are often not feasible, we review the available classes of rescue agents for akathisia symptoms. The fitting acronym, "B-CALM", which stands for Beta-blockers, Clonazepam, Anticholinergics, cLonidine and Mirtazapine, will assist prescribers in facile recall of evidence-based treatment options for akathisia. Pharmacological agents such as mianserin, trazodone, Vit B6, amantadine, gabapentin, and pregabalin have also been examined as treatment options for antipsychotic-induced akathisia. Although initial exploratory reports on these agents have been promising, the current evidence is insufficient. Akathisia has a good prognosis when managed early in the course of treatment. A variety of safe rescue agents are available for the management of this condition, however, current evidence best supports the use of propranolol and mirtazapine.

无运动障碍是一种影响躯干和四肢的运动障碍,以主客观不安为特征。主要症状包括持续、重复的摇晃、拖腿和坐立不安。抗精神病药物引起的静坐症的最佳治疗方法是减少药物剂量或改用不易引起静坐症的第二代抗精神病药物。然而,由于药物的改变往往是不可行的,我们回顾现有的类救援药物对静坐症的症状。合适的首字母缩略词“B-CALM”代表了-受体阻滞剂、氯硝西泮、抗胆碱能药、氯定和米氮平,将帮助处方医生快速召回以证据为基础的肌静坐症治疗方案。药物制剂如米安色林、曲唑酮、维生素B6、金刚烷胺、加巴喷丁和普瑞巴林也被研究作为抗精神病性静坐症的治疗选择。虽然关于这些药物的初步探索性报告很有希望,但目前的证据不足。如果在治疗过程中及早处理,无运动障碍有良好的预后。各种安全的救援剂可用于这种情况的管理,然而,目前的证据最支持使用心得安和米氮平。
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引用次数: 0
MDMA to Treat PTSD in Adults. MDMA治疗成人PTSD。
Q3 Medicine Pub Date : 2021-06-01
Dustin Latimer, Michael D Stocker, Kia Sayers, Jackson Green, Adam M Kaye, Alaa Abd-Elsayed, Elyse M Cornett, Alan D Kaye, Giustino Varrassi, Omar Viswanath, Ivan Urits

Post-traumatic stress disorder (PTSD) has become one of the most common psychiatric diagnosis in the United States specifically within the veteran population. The current treatment options for this debilitating diagnosis include trauma-focused psychotherapies along with selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI).1 MDMA has recently been shown as a novel therapeutic agent with promisingly results in the treatment of PTSD. MDMA is a psychoactive compound traditionally categorized as a psychedelic amphetamine that deemed a Schedule I controlled substance in the 1980s. Prior to its status as a controlled substance, it was used by psychotherapists for an array of psychiatric issues. In more recent times, MDMA has resurfaced as a potential therapy for PTSD and the data produced from randomized, controlled trials back the desire for MDMA to be utilized as an effective pharmacologic therapy in conjunction with psychotherapy.2.

创伤后应激障碍(PTSD)已经成为美国最常见的精神病诊断之一,特别是在退伍军人人群中。目前对这种衰弱性诊断的治疗选择包括以创伤为重点的心理治疗以及选择性血清素再摄取抑制剂(SSRI)和血清素-去甲肾上腺素再摄取抑制剂(SNRI)MDMA最近被证明是一种新的治疗药物,在治疗创伤后应激障碍方面有很好的效果。MDMA是一种精神活性化合物,传统上被归类为迷幻药安非他明,在20世纪80年代被列为一级管制物质。在它被列为管制药物之前,它被心理治疗师用于治疗一系列精神问题。最近,MDMA作为一种潜在的治疗创伤后应激障碍的方法重新出现,随机对照试验的数据支持MDMA作为一种有效的药物治疗与心理治疗相结合的愿望。
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引用次数: 0
Developing an IV Ketamine Clinic for Treatment-Resistant Depression: a Primer. 建立静脉注射氯胺酮治疗难治性抑郁症的临床:引物。
Q3 Medicine Pub Date : 2021-06-01
Sagar V Parikh, Daniela Lopez, Jennifer L Vande Voort, Jose Rico, Eric Achtyes, William Coryell, Andrew Goddard, Fernando Goes, John F Greden, Balwinder Singh, Adam Kaplin, Mark A Frye, Daniel Maixner, Brendon Watson, Karina Drake, Vijay Tarnal, Patricio Riva-Posse, William V Bobo, Bio-K Study Team

The efficacy of subanesthetic intravenous ketamine for treatment resistant depression (TRD) has spurred a growth of clinics nationwide that provide this service. Ketamine is an FDA-approved drug as an anesthetic but remains unapproved for psychiatric indications, and this status raises a number of short- and long-term safety and efficacy concerns that need to be addressed when implementing and developing this type of clinic. Using a framework of systems, provider, and patient domains, we provide a review of the key challenges in providing ketamine infusions and suggest potential approaches. Under systems issues, we highlight broad stakeholder engagement involving cross-departmental and multidisciplinary considerations, business case development, and delineation of administrative standard operating procedures. In the provider domain, we highlight specific roles for different treatment team members as well as suggested training requirements. In the patient domain, we identify a variety of standard operating procedures involving initial patient assessment parameters, ketamine dosing and administration guidelines, and safety monitoring procedures. Together, this review provides key considerations for developing a ketamine clinic for depression, in an effort to meet the pressing demand for this novel treatment option while helping to ensure its safe implementation.

亚麻醉静脉注射氯胺酮治疗难治性抑郁症(TRD)的疗效刺激了全国提供这种服务的诊所的增长。氯胺酮是fda批准的麻醉剂,但仍未被批准用于精神适应症,这一状况引发了一些短期和长期的安全性和有效性问题,在实施和发展这类诊所时需要解决这些问题。使用系统、提供者和患者领域的框架,我们提供了提供氯胺酮输注的主要挑战的审查,并提出了潜在的方法。在系统问题下,我们强调广泛的利益相关者参与,包括跨部门和多学科的考虑,业务案例开发,以及行政标准操作程序的描述。在提供者领域,我们强调不同治疗团队成员的特定角色以及建议的培训需求。在患者领域,我们确定了各种标准操作程序,包括初始患者评估参数,氯胺酮剂量和给药指南以及安全监测程序。总之,本综述为开发氯胺酮治疗抑郁症的诊所提供了关键考虑因素,以努力满足对这种新型治疗方案的迫切需求,同时帮助确保其安全实施。
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引用次数: 0
ADHD and Drug Holidays: Effects on Anthropometric Changes during Methylpenidate Treatment. ADHD和药物假期:哌甲酯治疗期间人体测量变化的影响。
Q3 Medicine Pub Date : 2021-06-01
Serkan Turan, Çağatay Ermiş, Victor Pereira-Sanchez, Mustafa Tunctürk, Aynur Akay Pekcanlar

Objectives: The current study evaluated the long-term effects of methylphenidate (MPH) discontinuation on growth parameters in Turkish children and adolescents with attention-deficit/hyperactivity disorder (ADHD).

Experimental design: 432 children and adolescents (aged 6-18 years) with ADHD receiving MPH for at least 1 year between March 2012 and January 2019 were included in a retrospective cohort study. We analyzed weight, height, and body mass index (BMI) standard deviation z scores (SDS) of groups that either did (ADHD-C) or did not (ADHD-DC) discontinue MPH. Growth parameters were converted to z scores as normative values for the Turkish population to compare the measurements at baseline and the last follow-up visit by using the paired sample t-test.

Principal observations: In patients from the ADHD-C group, statistically significant negative correlations were found between age at starting MPH and differences in weight and height SDS between baseline and follow-up. Children had a greater reduction in weight and height compared to adolescents. When we evaluated the differences in pre-and post-treatment growth factors, we found no significant differences between the groups in terms of growth parameters.

Conclusions: Our data showed that chronic use of MPH was likely responsible for changes in height and weight parameters.

目的:目前的研究评估了哌醋甲酯(MPH)停药对土耳其患有注意力缺陷/多动障碍(ADHD)的儿童和青少年生长参数的长期影响。实验设计:2012年3月至2019年1月期间,432名患有ADHD的儿童和青少年(6-18岁)接受MPH治疗至少1年,纳入回顾性队列研究。我们分析了(ADHD-C)和(ADHD-DC)两组的体重、身高和身体质量指数(BMI)标准差z分数(SDS)。使用配对样本t检验将生长参数转换为z分数作为土耳其人口的规范性值,以比较基线和最后一次随访时的测量结果。主要观察结果:在ADHD-C组患者中,开始MPH时的年龄与基线和随访期间体重和身高SDS的差异之间存在统计学上显著的负相关。与青少年相比,儿童的体重和身高下降幅度更大。当我们评估治疗前和治疗后生长因子的差异时,我们发现两组之间在生长参数方面没有显著差异。结论:我们的数据显示,长期使用MPH可能导致身高和体重参数的变化。
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引用次数: 0
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