Volume 15 • 2013 • Number 5
Reducing the Burden of Difficult-to-Treat Major Depressive Disorder: Revisiting Monoamine Oxidase Inhibitor Therapy
- Clinicians are advised to consider monoamine oxidase inhibitors (MAOIs) for patients who have had several unsuccessful trials of antidepressants or for patients with anxious or atypical symptoms.
- Clinicians should provide education to their patients about MAOIs and their risks, monitor for adverse effects, and safeguard against hypertensive crisis and serotonin syndrome, which can occur with certain foods and when co-administered with adrenergic and serotonergic medications.
- Guidelines generally reserve MAOIs as third- and fourth-line treatments due to concerns over safety and tolerability, but transdermal delivery may allay some of those concerns.
Depression Treatment in Patients With Coronary Artery Disease: A Systematic Review
- After acute coronary syndrome, depression symptoms should be monitored. Transient mild or moderate depression does not affect prognosis, but persistence of depression is a high-risk marker for adverse coronary events.
- The Coronary Psychosocial Evaluation Studies intervention, in which patients could choose between problem-solving therapy and/or antidepressants, improved coronary artery disease outcomes in patients with persistent depression after acute coronary syndrome.
- Among patients with coronary artery disease, prescription of noradrenergic antidepressants should be done with caution in consultation with the patient’s internist or cardiologist.
Descriptive Analysis of a Novel Health Care Approach: Reverse Colocation—Primary Care in a Community Mental Health “Home”
- People with severe mental illness die, on average, 25 years earlier than the general public mostly from preventable diseases like cardiovascular disease.
- Colocation of primary care services in the community mental health clinic is a newer form of integration and not well characterized.
- Referral for colocated services appears to be based primarily on level of mental health rather than medical illness.
- The most common medical illnesses in this colocated clinic were related to metabolic syndrome.
- Further research is necessary to determine if reverse colocation is effective and, if so, for which group of patients does it best serve.
A Review of Therapeutic Uses of Mirtazapine in Psychiatric and Medical Conditions
- Mirtazapine leads to rapid and sustained improvement in depressive symptoms and is effective in subgroups of depressed patients, particularly anxious patients and those with melancholic depression, treatment-resistant depression, geriatric depression, depression and anxiety associated with alcohol dependence, and agitated elderly patients.
- Mirtazapine’s range of clinically useful applications includes improved sleep, antiemetic benefits, improved appetite, pain management, and weight gain.
- There is no conclusive evidence to support the use of mirtazapine for treatment of depression associated with dementia, treatment of depression with cocaine dependence, or treatment of obstructive sleep apnea.
Pain and Pain Catastrophizing Among Internal Medicine Outpatients With Borderline Personality Symptomatology: A Cross-Sectional Self-Report Survey
- Patients with borderline personality features report higher levels of pain as well as pain catastrophizing—characteristics that may need to be factored into the pain assessments for these individuals.
- When present, borderline personality disorder is often associated with substance misuse as well as suicide attempts—factors that need to be considered in the pharmacologic management of such individuals who present with pain.
- Overall, the presence of borderline personality disorder in a patient with pain indicates the need for closer clinical monitoring (eg, prescriptions, outside prescribers, suicide risk).
Management of Depression Induced by Interferon Hepatitis Therapies
- For optimal results, antidepressant pharmacotherapy should start 3 months before initiating interferon therapy.
- Most of the antidepressant drugs are effective in treating affective disorders; however, limited efficacy has been reported in the prevention of interferon-induced depression.
Rounds from Banner Alzheimer's Institute
Hypersexuality in Dementia: A Case Presentation With Discussion [CME]
- Despite the fact that hypersexuality affects up to 17% of all patients with dementia, there are currently no US Food and Drug Administration–approved treatments or official guidelines for treating sexually disinhibited behaviors in dementia.
- Nonpharmacologic interventions should be attempted first and require a thorough assessment of problem behaviors, the context in which they occur, who is distressed by the behavior, frequency, contributing factors, and associated risks.
- Since little is published on pharmacologic treatment of hypersexuality in dementia, data are insufficient to dictate best clinical practice. Results extrapolated from treatment studies of patients with paraphilias and of sexual offenders may be helpful in guiding pharmacologic treatment.
Rounds in the General Hospital
Obesity: Its Epidemiology, Comorbidities, and Management
- Patients with psychiatric disorders are especially prone to the development of obesity and metabolic derangements.
- Physicians caring for patients with psychiatric disorders should conduct careful assessments of obesity risk factors and metabolic derangements.
- Numerous treatment modalities have shown success in the treatment of obesity in patients with psychiatric disorders as well as those in the general population.
- Patients with preexisting mental illness or disordered eating are especially vulnerable to complications following bariatric surgery.
Teaching Our Young
Toxic Effects of Psychotropics Related to Possible P450 Enzyme Inhibition by Kava: Report of 2 Cases
Letters to the Editor
Insomnia Severity Is Associated With Decreased Executive Functioning in Patients With Suicidal Ideation and Drug Abuse
Exposure to Potent Hallucinogens in an Adolescent: A Case for High Index of Suspicion
Psychiatric Pharmacist Management of Depression in Patients With Diabetes
Sublingual Buprenorphine and Dental Problems: A Case Series
Abuse of Prescription Medication, Alcohol, and Drugs Among Internal Medicine Outpatients
Treating Symptomatic Hyperprolactinemia Secondary to a Long-Acting Injectable Atypical Antipsychotic in a Patient With Bipolar Disorder Due to an Anoxic Brain Injury
Recurrent Seizures in a Depressed Patient
Cultural Adaptation and Individual Tailoring: Two Approaches to the Development of Culturally Responsive Treatment