Pub Date : 2016-02-01DOI: 10.1177/0091217416636575
Russell S Blackwelder, S. Bragg
Anxiety disorders are common illnesses for patients that can significantly impact quality of life. These conditions are complicated and advanced by chronic illness. It can be a challenge not only for patients to live with but also for providers to evaluate and treat. Several tools exist to support clinicians in their work to manage and improve patient symptoms and reduce the burden of the disease. While there are numerous treatment modalities that are shown to help control and alleviate symptoms, close monitoring and evaluation are essential for improved patient outcomes and proper use of available resources.
{"title":"Anxiety disorders","authors":"Russell S Blackwelder, S. Bragg","doi":"10.1177/0091217416636575","DOIUrl":"https://doi.org/10.1177/0091217416636575","url":null,"abstract":"Anxiety disorders are common illnesses for patients that can significantly impact quality of life. These conditions are complicated and advanced by chronic illness. It can be a challenge not only for patients to live with but also for providers to evaluate and treat. Several tools exist to support clinicians in their work to manage and improve patient symptoms and reduce the burden of the disease. While there are numerous treatment modalities that are shown to help control and alleviate symptoms, close monitoring and evaluation are essential for improved patient outcomes and proper use of available resources.","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"14 1","pages":"137 - 144"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89184393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-02-01DOI: 10.1177/0091217416636578
Ann C. Schwartz, T. Fisher, Heather N Greenspan, T. Heinrich
Delirium is a syndrome of neuropsychiatric signs and symptoms that can accompany virtually any serious medical condition. Delirium is characterized by a disturbance of attention and awareness, as well as variety of other aspects of cognition that develops over a short period of time in response to another medical condition. It is an independent risk factor for increased morbidity and mortality and is associated with increased lengths of stay and costs of care. Despite this, it frequently goes unrecognized, and debate continues about the best prevention and treatment strategies. This article will review the current best practices for the prevention and treatment of delirium and how collaborative care can aid in improving outcomes and minimizing adverse events for patients suffering from delirium.
{"title":"Pharmacologic and nonpharmacologic approaches to the prevention and management of delirium","authors":"Ann C. Schwartz, T. Fisher, Heather N Greenspan, T. Heinrich","doi":"10.1177/0091217416636578","DOIUrl":"https://doi.org/10.1177/0091217416636578","url":null,"abstract":"Delirium is a syndrome of neuropsychiatric signs and symptoms that can accompany virtually any serious medical condition. Delirium is characterized by a disturbance of attention and awareness, as well as variety of other aspects of cognition that develops over a short period of time in response to another medical condition. It is an independent risk factor for increased morbidity and mortality and is associated with increased lengths of stay and costs of care. Despite this, it frequently goes unrecognized, and debate continues about the best prevention and treatment strategies. This article will review the current best practices for the prevention and treatment of delirium and how collaborative care can aid in improving outcomes and minimizing adverse events for patients suffering from delirium.","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"456 1","pages":"160 - 170"},"PeriodicalIF":0.0,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88181892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.1177/0091217415621267
K. Casaletto, Sara Kwan, Jessica L. Montoya, L. Obermeit, B. Gouaux, Amelia J. Poquette, R. Heaton, J. Atkinson, D. Moore
Objective HIV infection and bipolar disorder are highly comorbid and associated with frontostriatal disruption, emotional dysregulation, and neurocognitive impairment. Psychiatric and cognitive factors have been linked to antiretroviral nonadherence; however, predictors of psychotropic adherence among HIV+ individuals with psychiatric comorbidities have not been explored. We evaluated predictors of psychotropic adherence among individuals with HIV infection and bipolar disorder. Method Psychiatric medication adherence of 50 participants with HIV infection and bipolar disorder was tracked for 30 days using Medication Event Monitoring Systems. Participants completed neurocognitive, neuromedical, and psychiatric batteries. Results Mean psychotropic adherence rate was 78%; 56% of participants achieved ≥90% adherence. Younger age and onset of depressive symptoms, more severe current depressive symptoms, number of previous psychiatric hospitalizations and suicide attempts, poorer neurocognition, and more negative attitudes and self-beliefs toward medications univariably predicted worse psychotropic adherence (p’s < .10). A multivariable model demonstrated a combination of current depressive symptoms and more negative attitudes toward medications significantly predicting poorer adherence (R2 = 0.27, p < 0.003). Secondary analyses revealed an interaction between neurocognition and mood, such that individuals with HIV infection and bipolar disorder who had greater executive dysfunction and depressive symptoms evidenced the poorest psychotropic adherence (p < 0.001). Conclusions Both psychiatric and neurocognitive factors contribute to poorer psychotropic adherence among HIV+ individuals with serious mental illness. Adherence interventions aimed at remediating these factors may be especially fruitful.
目的HIV感染和双相情感障碍是高度合并症，并与额纹状体破坏、情绪失调和神经认知障碍相关。精神和认知因素与抗逆转录病毒不依从性有关;然而，有精神合并症的HIV阳性个体的精神药物依从性的预测因素尚未被探索。我们评估了HIV感染和双相情感障碍患者精神药物依从性的预测因素。方法采用药物事件监测系统对50例HIV感染合并双相情感障碍患者进行为期30天的精神药物依从性监测。参与者完成了神经认知、神经医学和精神病学测试。结果平均精神药物依从率为78%;56%的参与者达到≥90%的依从性。年龄和抑郁症状的年龄越小，当前抑郁症状越严重，既往精神科住院和自杀未遂次数越多，神经认知能力越差，对药物的态度和自我信念越消极，这些都不可避免地预示着更差的精神药物依从性(p < 0.10)。多变量模型显示，当前抑郁症状和对药物更消极的态度的结合显著预测较差的依从性(R2 = 0.27, p < 0.003)。二次分析揭示了神经认知和情绪之间的相互作用，例如，艾滋病毒感染和双相情感障碍患者有更大的执行功能障碍和抑郁症状，证明精神药物依从性最差(p < 0.001)。结论精神和神经认知因素共同导致严重精神疾病的HIV阳性患者精神药物依从性较差。旨在纠正这些因素的依从性干预措施可能特别富有成效。
{"title":"Predictors of psychotropic medication adherence among HIV+ individuals living with bipolar disorder","authors":"K. Casaletto, Sara Kwan, Jessica L. Montoya, L. Obermeit, B. Gouaux, Amelia J. Poquette, R. Heaton, J. Atkinson, D. Moore","doi":"10.1177/0091217415621267","DOIUrl":"https://doi.org/10.1177/0091217415621267","url":null,"abstract":"Objective HIV infection and bipolar disorder are highly comorbid and associated with frontostriatal disruption, emotional dysregulation, and neurocognitive impairment. Psychiatric and cognitive factors have been linked to antiretroviral nonadherence; however, predictors of psychotropic adherence among HIV+ individuals with psychiatric comorbidities have not been explored. We evaluated predictors of psychotropic adherence among individuals with HIV infection and bipolar disorder. Method Psychiatric medication adherence of 50 participants with HIV infection and bipolar disorder was tracked for 30 days using Medication Event Monitoring Systems. Participants completed neurocognitive, neuromedical, and psychiatric batteries. Results Mean psychotropic adherence rate was 78%; 56% of participants achieved ≥90% adherence. Younger age and onset of depressive symptoms, more severe current depressive symptoms, number of previous psychiatric hospitalizations and suicide attempts, poorer neurocognition, and more negative attitudes and self-beliefs toward medications univariably predicted worse psychotropic adherence (p’s < .10). A multivariable model demonstrated a combination of current depressive symptoms and more negative attitudes toward medications significantly predicting poorer adherence (R2 = 0.27, p < 0.003). Secondary analyses revealed an interaction between neurocognition and mood, such that individuals with HIV infection and bipolar disorder who had greater executive dysfunction and depressive symptoms evidenced the poorest psychotropic adherence (p < 0.001). Conclusions Both psychiatric and neurocognitive factors contribute to poorer psychotropic adherence among HIV+ individuals with serious mental illness. Adherence interventions aimed at remediating these factors may be especially fruitful.","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"133 1","pages":"69 - 83"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79667809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.1177/0091217415621269
N. Chopra, J. de Leon
Clozapine-induced myocarditis is a poorly understood, rare, potentially fatal adverse drug reaction with absolute risks ranging from 7 to 34 per 1000 in Australia and 0.07–0.6 per 1000 in other countries. Hypersensitivity reactions have been postulated including some cases probably associated with rapid titrations. This case describes a 50-year-old African-American man with schizoaffective disorder, naïve to clozapine, who probably died from clozapine-induced myocarditis. He was started on 25 mg/day of clozapine and received 1625 mg over 14 days, prior to his death on day 15. The autopsy found predominantly lymphocytic infiltrate of the perivascular soft tissue and myocardium of the ventricles, with occasional eosinophils. Using the Liverpool ADR Causality Assessment Tool, it was deemed probable that the patient’s death was secondary to myocarditis. The patient had fulminant death with no obvious changes in vital signs. Neither C-reactive protein nor troponin was measured, but it is unlikely that the results would have arrived in time to prevent the patient’s death. Age, rapid titration, and concomitant use of valproate contributed to this case, which was probably an idiosyncratic adverse drug reaction associated with rapid titration. Lamotrigine-induced Stevens-Johnson syndrome also appears to be an idiosyncratic adverse drug reaction associated with rapid titration, but its incidence has been remarkably reduced since the recommended starting lamotrigine dose was reduced and corrected by the effect of inhibitors such as valproate. Similarly, clozapine-induced myocarditis incidence probably can be reduced with the use of slow titrations, including even slower titrations for patients with lower ability to metabolize clozapine, such as those taking valproate.
{"title":"Clozapine-induced myocarditis may be associated with rapid titration","authors":"N. Chopra, J. de Leon","doi":"10.1177/0091217415621269","DOIUrl":"https://doi.org/10.1177/0091217415621269","url":null,"abstract":"Clozapine-induced myocarditis is a poorly understood, rare, potentially fatal adverse drug reaction with absolute risks ranging from 7 to 34 per 1000 in Australia and 0.07–0.6 per 1000 in other countries. Hypersensitivity reactions have been postulated including some cases probably associated with rapid titrations. This case describes a 50-year-old African-American man with schizoaffective disorder, naïve to clozapine, who probably died from clozapine-induced myocarditis. He was started on 25 mg/day of clozapine and received 1625 mg over 14 days, prior to his death on day 15. The autopsy found predominantly lymphocytic infiltrate of the perivascular soft tissue and myocardium of the ventricles, with occasional eosinophils. Using the Liverpool ADR Causality Assessment Tool, it was deemed probable that the patient’s death was secondary to myocarditis. The patient had fulminant death with no obvious changes in vital signs. Neither C-reactive protein nor troponin was measured, but it is unlikely that the results would have arrived in time to prevent the patient’s death. Age, rapid titration, and concomitant use of valproate contributed to this case, which was probably an idiosyncratic adverse drug reaction associated with rapid titration. Lamotrigine-induced Stevens-Johnson syndrome also appears to be an idiosyncratic adverse drug reaction associated with rapid titration, but its incidence has been remarkably reduced since the recommended starting lamotrigine dose was reduced and corrected by the effect of inhibitors such as valproate. Similarly, clozapine-induced myocarditis incidence probably can be reduced with the use of slow titrations, including even slower titrations for patients with lower ability to metabolize clozapine, such as those taking valproate.","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"68 1 1","pages":"104 - 115"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83452655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.1177/0091217415621032
M. Sehlo, Owiss Alzahrani, H. Alzahrani
Objectives (1) To assess the prevalence of depressive disorders in a sample of diabetic patients with their first superficial diabetic foot ulcer. (2) To evaluate the association between illness invalidation from spouse, family, and depressive disorders in those patients. Methods Depressive disorders and severity were diagnosed by the Structured Clinical Interview for DSM-IV Axis Ι disorders, clinical version, and the spouse and family scales of the Illness Invalidation Inventory, respectively (3*I). Physical functioning was also assessed using the Physical Component of The Short Form 36 item health-related quality of life questionnaire. Results The prevalence of depressive disorders was 27.50% (22/80). There was a significant decrease in physical health component summary mean score and a significant increase in ulcer size, Center for Epidemiologic Studies–Depression Scale, spouse discounting, spouse lack of understanding, and family discounting mean scores in the depressed group compared to the non-depressed group. Higher levels of spouse discounting, spouse understanding, and family discounting were significant predictors of diagnosis of depressive disorders and were strongly associated with increased severity of depressive symptoms in diabetic patients with first superficial diabetic foot ulcers. Poor physical functioning was associated with increased depressive symptom severity. Conclusion This study demonstrated that illness invalidation from spouse and family is associated with diagnosis of depressive disorders and increased severity of depressive symptoms in diabetic patients with first superficial diabetic foot ulcers.
{"title":"Illness invalidation from spouse and family is associated with depression in diabetic patients with first superficial diabetic foot ulcers","authors":"M. Sehlo, Owiss Alzahrani, H. Alzahrani","doi":"10.1177/0091217415621032","DOIUrl":"https://doi.org/10.1177/0091217415621032","url":null,"abstract":"Objectives (1) To assess the prevalence of depressive disorders in a sample of diabetic patients with their first superficial diabetic foot ulcer. (2) To evaluate the association between illness invalidation from spouse, family, and depressive disorders in those patients. Methods Depressive disorders and severity were diagnosed by the Structured Clinical Interview for DSM-IV Axis Ι disorders, clinical version, and the spouse and family scales of the Illness Invalidation Inventory, respectively (3*I). Physical functioning was also assessed using the Physical Component of The Short Form 36 item health-related quality of life questionnaire. Results The prevalence of depressive disorders was 27.50% (22/80). There was a significant decrease in physical health component summary mean score and a significant increase in ulcer size, Center for Epidemiologic Studies–Depression Scale, spouse discounting, spouse lack of understanding, and family discounting mean scores in the depressed group compared to the non-depressed group. Higher levels of spouse discounting, spouse understanding, and family discounting were significant predictors of diagnosis of depressive disorders and were strongly associated with increased severity of depressive symptoms in diabetic patients with first superficial diabetic foot ulcers. Poor physical functioning was associated with increased depressive symptom severity. Conclusion This study demonstrated that illness invalidation from spouse and family is associated with diagnosis of depressive disorders and increased severity of depressive symptoms in diabetic patients with first superficial diabetic foot ulcers.","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"132 1","pages":"16 - 30"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76716071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.1177/0091217415621265
Hui Li, D. Jin, F. Qiao, Jianchang Chen, J. Gong
Objective Computed tomography coronary angiography, a key method for obtaining coronary artery images, is widely used to screen for coronary artery diseases due to its noninvasive nature. In China, 64-slice computed tomography systems are now the most common models. As factors that directly affect computed tomography performance, heart rate and rhythm control are regulated by the autonomic nervous system and are highly related to the emotional state of the patient. The aim of this prospective study is to use a pre-computed tomography scan Self-Rating Anxiety Scale assessment to analyze the effects of tension and anxiety on computed tomography coronary angiography success. Methods Subjects aged 18–85 years who were planned to undergo computed tomography coronary angiography were enrolled; 1 to 2 h before the computed tomography scan, basic patient data (gender, age, heart rate at rest, and family history) and Self-Rating Anxiety Scale score were obtained. The same group of imaging department doctors, technicians, and nurses performed computed tomography coronary angiography for all the enrolled subjects and observed whether those subjects could finish the computed tomography coronary angiography scan and provide clear, diagnostically valuable images. Participants were divided into successful (obtained diagnostically useful coronary images) and unsuccessful groups. Basic data and Self-Rating Anxiety Scale scores were compared between the groups. Results The Self-Rating Anxiety Scale standard score of the successful group was lower than that of the unsuccessful group (P = 0.001). As the Self-Rating Anxiety Scale standard score rose, the success rate of computed tomography coronary angiography decreased. Conclusions The Self-Rating Anxiety Scale score has a negative relationship with computed tomography coronary angiography success. Advances in knowledge Anxiety can be a disadvantage in computed tomography coronary angiography examination. The pre-computed tomography coronary angiography scan Self-Rating Anxiety Scale score may be a useful tool for assessing whether a computed tomography coronary angiography scan will be successful or not.
{"title":"Relationship between the Self-Rating Anxiety Scale score and the success rate of 64-slice computed tomography coronary angiography","authors":"Hui Li, D. Jin, F. Qiao, Jianchang Chen, J. Gong","doi":"10.1177/0091217415621265","DOIUrl":"https://doi.org/10.1177/0091217415621265","url":null,"abstract":"Objective Computed tomography coronary angiography, a key method for obtaining coronary artery images, is widely used to screen for coronary artery diseases due to its noninvasive nature. In China, 64-slice computed tomography systems are now the most common models. As factors that directly affect computed tomography performance, heart rate and rhythm control are regulated by the autonomic nervous system and are highly related to the emotional state of the patient. The aim of this prospective study is to use a pre-computed tomography scan Self-Rating Anxiety Scale assessment to analyze the effects of tension and anxiety on computed tomography coronary angiography success. Methods Subjects aged 18–85 years who were planned to undergo computed tomography coronary angiography were enrolled; 1 to 2 h before the computed tomography scan, basic patient data (gender, age, heart rate at rest, and family history) and Self-Rating Anxiety Scale score were obtained. The same group of imaging department doctors, technicians, and nurses performed computed tomography coronary angiography for all the enrolled subjects and observed whether those subjects could finish the computed tomography coronary angiography scan and provide clear, diagnostically valuable images. Participants were divided into successful (obtained diagnostically useful coronary images) and unsuccessful groups. Basic data and Self-Rating Anxiety Scale scores were compared between the groups. Results The Self-Rating Anxiety Scale standard score of the successful group was lower than that of the unsuccessful group (P = 0.001). As the Self-Rating Anxiety Scale standard score rose, the success rate of computed tomography coronary angiography decreased. Conclusions The Self-Rating Anxiety Scale score has a negative relationship with computed tomography coronary angiography success. Advances in knowledge Anxiety can be a disadvantage in computed tomography coronary angiography examination. The pre-computed tomography coronary angiography scan Self-Rating Anxiety Scale score may be a useful tool for assessing whether a computed tomography coronary angiography scan will be successful or not.","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"21 1","pages":"47 - 55"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84122709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.1177/0091217415621266
M. Shapiro, A. Reid, B. Olsen, M. Taasan, J. Mcnamara, M. Nguyen
Background Childhood obesity is a growing epidemic that is contributed to by the use of psychopharmacological agents, such as antipsychotics. This study represents a preliminary investigation into the effectiveness of two anticonvulsants that were hypothesized to reduce weight in a pediatric sample seeking treatment at a psychiatric clinic. Methods The electronic medical records of a university-based child and adolescent psychiatric clinic were reviewed for patients who were first prescribed either topiramate or zonisamide between 1 July 2011 and 30 June 2013. Based on inclusionary criteria, the review identified 47 children or adolescents. Results Multilevel modeling was utilized for study analyses. Including the full sample and controlling for confounders, anticonvulsant dosage was uniquely associated with an average reduction in body mass index of 1.3 (dosages above 200 mg) to 4.1 (dosages below 50 mg) every six months of treatment. Exlucing patients whose baseline body mass index was below 25.0 and controlling for confounders, anticonvulsant dosage was uniquely associated with an average reduction in body mass index of 3.2 (dosages above 200 mg) to 6.1 (dosages below 50 mg) every six months of treatment. Weight reduction was not statistically different between topiramate or zonisamide. Anticonvulsants were associated with an increase in body mass index, yet the benefits of the two anticonvulsants on weight loss remained despite the counteractive effects of antipsychotics. Conclusions Results provide preliminary evidence that topiramate and zonisamide may be utilized for weight loss in a pediatric psychopharmacological treatment seeking sample, even if antipsychotics are also prescribed. A randomized controlled trial investigating the impact of topiramate and zonisamide on weight reduction is warranted.
{"title":"Topiramate, zonisamide and weight loss in children and adolescents prescribed psychiatric medications","authors":"M. Shapiro, A. Reid, B. Olsen, M. Taasan, J. Mcnamara, M. Nguyen","doi":"10.1177/0091217415621266","DOIUrl":"https://doi.org/10.1177/0091217415621266","url":null,"abstract":"Background Childhood obesity is a growing epidemic that is contributed to by the use of psychopharmacological agents, such as antipsychotics. This study represents a preliminary investigation into the effectiveness of two anticonvulsants that were hypothesized to reduce weight in a pediatric sample seeking treatment at a psychiatric clinic. Methods The electronic medical records of a university-based child and adolescent psychiatric clinic were reviewed for patients who were first prescribed either topiramate or zonisamide between 1 July 2011 and 30 June 2013. Based on inclusionary criteria, the review identified 47 children or adolescents. Results Multilevel modeling was utilized for study analyses. Including the full sample and controlling for confounders, anticonvulsant dosage was uniquely associated with an average reduction in body mass index of 1.3 (dosages above 200 mg) to 4.1 (dosages below 50 mg) every six months of treatment. Exlucing patients whose baseline body mass index was below 25.0 and controlling for confounders, anticonvulsant dosage was uniquely associated with an average reduction in body mass index of 3.2 (dosages above 200 mg) to 6.1 (dosages below 50 mg) every six months of treatment. Weight reduction was not statistically different between topiramate or zonisamide. Anticonvulsants were associated with an increase in body mass index, yet the benefits of the two anticonvulsants on weight loss remained despite the counteractive effects of antipsychotics. Conclusions Results provide preliminary evidence that topiramate and zonisamide may be utilized for weight loss in a pediatric psychopharmacological treatment seeking sample, even if antipsychotics are also prescribed. A randomized controlled trial investigating the impact of topiramate and zonisamide on weight reduction is warranted.","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"33 1","pages":"56 - 68"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85056098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.1177/0091217415621268
David R. Spiegel, A. Shaukat, Aidan L Mccroskey, A. Chatterjee, T. Ahmadi, Drew Simmelink, E. Oldfield, Christopher R Pryor, Michael Faschan, Olivia Raulli
Lifetime history of sexual abuse is estimated to range between 15% and 25% in the general female population. Cross-sectional studies have shown that sexual assault survivors frequently report chronic musculoskeletal pain and functional somatic syndromes. Treating chronic pain with opioids went from being largely discouraged to being included in standards of care and titrating doses until patients self-report adequate control has become common practice, with 8% to 30% of patients with chronic noncancer pain receiving opioids. In this clinical review, we will discuss the association between survivors of sexual assault and chronic pain/functional somatic syndromes. We will further review evidence-based treatment strategies for this “pain-prone phenotype.”
{"title":"Conceptualizing a subtype of patients with chronic pain","authors":"David R. Spiegel, A. Shaukat, Aidan L Mccroskey, A. Chatterjee, T. Ahmadi, Drew Simmelink, E. Oldfield, Christopher R Pryor, Michael Faschan, Olivia Raulli","doi":"10.1177/0091217415621268","DOIUrl":"https://doi.org/10.1177/0091217415621268","url":null,"abstract":"Lifetime history of sexual abuse is estimated to range between 15% and 25% in the general female population. Cross-sectional studies have shown that sexual assault survivors frequently report chronic musculoskeletal pain and functional somatic syndromes. Treating chronic pain with opioids went from being largely discouraged to being included in standards of care and titrating doses until patients self-report adequate control has become common practice, with 8% to 30% of patients with chronic noncancer pain receiving opioids. In this clinical review, we will discuss the association between survivors of sexual assault and chronic pain/functional somatic syndromes. We will further review evidence-based treatment strategies for this “pain-prone phenotype.”","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"11 1","pages":"103 - 84"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85196925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.1177/0091217415621040
A. Doherty, C. Gayle, R. Morgan-Jones, N. Archer, Laura-Lee, K. Ismail, Anne Werner
Objective Many people with persistent suboptimal diabetes control also have psychiatric morbidity and social problems which interfere with their ability to self-manage their diabetes. Current models of care in the UK do not integrate these different dimensions of care or address inequalities between physical and mental health. 3DFD (3 Dimensions of Care For Diabetes) integrated medical, psychological, and social care in diabetes for patients with persistent suboptimal glycemic control (HbA1c > 75 mmol/mol) despite guideline-based routine diabetes care, to improve glycemic control, reduce psychological distress, and improve social functioning. Methods The service delivered interventions including brief psychological therapies, mental health assessments, psychotropic medications, and social support, enhanced by patient-led case conferences aiming to optimize diabetes care. 3DFD measured changes in HbA1c, psychological functioning, quality of life, rates of unscheduled care, and levels of engagement with routine diabetes care at baseline and at 12 months. Conclusion At 12-month follow-up, 3DFD patients achieved significant reductions in HbA1c of 15 mmol/mol, International Federation of Clinical Chemistry (1.4% Diabetes Control and Complications Trial) and improvements in depression scores and patient satisfaction. This model of care demonstrates that integrated care can improve diabetes outcomes in people with psychological and social comorbidities.
目的许多糖尿病持续控制不佳的患者还伴有精神疾病和社会问题，影响了他们自我管理糖尿病的能力。英国目前的护理模式没有整合这些不同的护理维度，也没有解决身心健康之间的不平等问题。3DFD (3 Dimensions of Care For Diabetes)对血糖控制持续欠佳(HbA1c低于75 mmol/mol)的糖尿病患者进行综合医疗、心理和社会护理，以改善血糖控制，减少心理困扰，改善社会功能。方法通过患者主导的病例会议，提供包括简短心理治疗、心理健康评估、精神药物治疗和社会支持在内的干预措施，以优化糖尿病护理。3DFD在基线和12个月时测量HbA1c、心理功能、生活质量、计划外护理率和常规糖尿病护理水平的变化。结论在随访12个月时，3DFD患者的HbA1c显著降低15 mmol/mol，国际临床化学联合会(1.4%糖尿病控制和并发症试验)，抑郁评分和患者满意度均有改善。这种护理模式表明，综合护理可以改善患有心理和社会合并症的糖尿病患者的预后。
{"title":"Improving quality of diabetes care by integrating psychological and social care for poorly controlled diabetes","authors":"A. Doherty, C. Gayle, R. Morgan-Jones, N. Archer, Laura-Lee, K. Ismail, Anne Werner","doi":"10.1177/0091217415621040","DOIUrl":"https://doi.org/10.1177/0091217415621040","url":null,"abstract":"Objective Many people with persistent suboptimal diabetes control also have psychiatric morbidity and social problems which interfere with their ability to self-manage their diabetes. Current models of care in the UK do not integrate these different dimensions of care or address inequalities between physical and mental health. 3DFD (3 Dimensions of Care For Diabetes) integrated medical, psychological, and social care in diabetes for patients with persistent suboptimal glycemic control (HbA1c > 75 mmol/mol) despite guideline-based routine diabetes care, to improve glycemic control, reduce psychological distress, and improve social functioning. Methods The service delivered interventions including brief psychological therapies, mental health assessments, psychotropic medications, and social support, enhanced by patient-led case conferences aiming to optimize diabetes care. 3DFD measured changes in HbA1c, psychological functioning, quality of life, rates of unscheduled care, and levels of engagement with routine diabetes care at baseline and at 12 months. Conclusion At 12-month follow-up, 3DFD patients achieved significant reductions in HbA1c of 15 mmol/mol, International Federation of Clinical Chemistry (1.4% Diabetes Control and Complications Trial) and improvements in depression scores and patient satisfaction. This model of care demonstrates that integrated care can improve diabetes outcomes in people with psychological and social comorbidities.","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"101 1","pages":"15 - 3"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81161145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.1177/0091217415621042
Jong-Il Park, Jong-Chul Yang, Tae Won Park, Sang-Keun Chung
Objective Mixed results exist regarding the role of vitamin D deficiency in depression and suicidal ideation. The present study investigated the relationships among vitamin D, depressive symptoms, and suicidal ideation in a large representative of the general population of Korea. Method The data from the fifth Korea National Health and Nutrition Examination Surveys conducted by the Division of Chronic Disease Surveillance, Korea Centers for Disease Control and Prevention, from 2010 to 2012 were investigated. A total of 15,695 subjects aged 20 and older were included in analysis. Depressive symptoms and suicidal ideation were evaluated based on self-report information. The serum 25-hydroxyvitamin D concentrations were measured by radioimmunoassay. The associations among vitamin D, depressive symptoms, and suicidal ideation were explored using multivariate logistic regression analysis adjusting for various confounding variables including sociodemographic and health-related variables. Results Serum 25-hydroxyvitamin D concentrations were not significantly different depending on the depressive symptoms (participant with depressive symptom, n = 2085, 17.10 ng/ml; without depressive symptom, n = 13,610, 17.36 ng/ml; p = 0.142) and suicidal ideation (participant with suicidal ideation, n = 2319, 17.31 ng/ml; without suicidal ideation, n = 13,374, 17.33 ng/ml; p = 0.926). After adjustment for sociodemographic and health-related factors, this lack of relationship was held consistent in the multivariate logistic regression. Conclusions Significant associations were not observed among vitamin D, depressive symptoms, and suicidal ideation in Korean adults. Further studies are warranted to gain a better understanding of the association among vitamin D, depressive symptoms, and suicidal ideation.
{"title":"Is serum 25-hydroxyvitamin D associated with depressive symptoms and suicidal ideation in Korean adults?","authors":"Jong-Il Park, Jong-Chul Yang, Tae Won Park, Sang-Keun Chung","doi":"10.1177/0091217415621042","DOIUrl":"https://doi.org/10.1177/0091217415621042","url":null,"abstract":"Objective Mixed results exist regarding the role of vitamin D deficiency in depression and suicidal ideation. The present study investigated the relationships among vitamin D, depressive symptoms, and suicidal ideation in a large representative of the general population of Korea. Method The data from the fifth Korea National Health and Nutrition Examination Surveys conducted by the Division of Chronic Disease Surveillance, Korea Centers for Disease Control and Prevention, from 2010 to 2012 were investigated. A total of 15,695 subjects aged 20 and older were included in analysis. Depressive symptoms and suicidal ideation were evaluated based on self-report information. The serum 25-hydroxyvitamin D concentrations were measured by radioimmunoassay. The associations among vitamin D, depressive symptoms, and suicidal ideation were explored using multivariate logistic regression analysis adjusting for various confounding variables including sociodemographic and health-related variables. Results Serum 25-hydroxyvitamin D concentrations were not significantly different depending on the depressive symptoms (participant with depressive symptom, n = 2085, 17.10 ng/ml; without depressive symptom, n = 13,610, 17.36 ng/ml; p = 0.142) and suicidal ideation (participant with suicidal ideation, n = 2319, 17.31 ng/ml; without suicidal ideation, n = 13,374, 17.33 ng/ml; p = 0.926). After adjustment for sociodemographic and health-related factors, this lack of relationship was held consistent in the multivariate logistic regression. Conclusions Significant associations were not observed among vitamin D, depressive symptoms, and suicidal ideation in Korean adults. Further studies are warranted to gain a better understanding of the association among vitamin D, depressive symptoms, and suicidal ideation.","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"2 1","pages":"31 - 46"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82996251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：